



















































































































































































































































































































































































































































































Me _ 

GopiglitS?_i9_E_4i 


COPYRIGHT DEPOSEIi 


















NUTRITION OF 
MOTHER AND CHILD 

C. ULYSSES MOORE, M.D. 


Lippincotts Nursing 
Manuals 

DESCRIPTIVE CATALOGUE ON REQUEST 


MENTAL HYGIENE AND THE PUBLIC HEALTH NURSE 

By V. MAY MacDONALD, R.N., Formerly Assistant Superintendent of 
Nurses, Johns Hopkins Hospital. 277 pages. 

NUTRITION OF MOTHER AND CHILD 

By C. ULYSSES MOORE, M.D.,of University of Oregon Medical School. 
27 illustrations. 

HOW WE RESIST DISEASE. An Introduction to Immunity 

By JEAN BROADHURST, Ph.D., of Teachers College, Columbia University. 
138 illustrations and 4 plates. 

AN INTRODUCTION TO APPLIED PSYCHOLOGY FOR NURSES 
By DONALD A. LAIRD, Department of Psychology, State University of 
Iowa. About 40 illustrations. 

COOKE’S HANDBOOK OF OBSTETRICS 

Revised by CAROLYN E. GRAY, R.N., and PHILIP F. WILLIAMS, M.D. 
Tenth edition, revised and enlarged, 468 pages, 189 illustrations and 4 full 
pages in color. 

CARE AND FEEDING OF INFANTS AND CHILDREN 

A Text-Book For Trained Nurses by WALTER REEVE RAMSEY, M.D., 
of University of Minnesota. Third edition, revised, 290 pages, 123 
illustrations. 

SURGICAL AND GYNAECOLOGICAL NURSING 

By EDWARD MASON PARKER, M.D. and SCOTT DUDLEY BRECKIN¬ 
RIDGE, M.D., of Providence Hospital, Washington, D. C. Second edition, 
revised, 425 pages, 134 illustrations. 

ESSENTIALS OF MEDICINE 

By CHARLES PHILLIPS EMERSON, M.D., of University of Indiana. 
Fifth edition revised, 401 pages, 117 illustrations. 

PHYSICS AND CHEMISTRY FOR NURSES 

By A. R. BLISS, Jr.. Ph.G., Ph.Cn., A.M., Phm.D., M.D., Grady Hospital, 
Atlanta, Ga., and A. H. OLIVE, A.B., Phm.D., Hillman Hospital, Birming¬ 
ham. Third edition, revised, 239 pages, 49 illustrations. 

MATERIA MEDICA AND THERAPEUTICS 

By JOHN FOOTE, M.D., of Providence Hospital, Washington, D. C. 
Third edition, revised and enlarged, 310 pages. 

FEVER NURSING 

By J. C. WILSON. A.M. M.D., of Jefferson Hospital. Philadelphia. Ninth 
edition, enlarged and revised, 271 pages, illustrated. 

PRACTICAL BANDAGING 

By ELDRIDGE L. ELIASON, A.B., M.D., F.A.C.S., University of Pennsyl¬ 
vania Hospital. Second edition, revised, 126 pages, 163 illustrations. 

ESSENTIALS OF SURGERY 

By DR. ARCHIBALD L. MCDONALD. Second edition, 265 pages, 46 
illustrations. 

HOME AND COMMUNITY HYGIENE 

By JEAN BROADHURST, Ph.D. Second Edition. 118 illustrations. 8 vo. 

MENTAL MEDICINE AND NURSING 

By ROBERT HOWLAND CHASE, M.D., Physician-in-Chief, Friends’ 
Asylum for the Insane. Third edition, revised, 244 pages, 78 illustrations. 

NURSING TECHNIC 

By MARY C. WHEELER, R.N., Superintendent Illinois Training School 
for Nurses, Chicago. Second edition, 265 pages, 32 illustrations. 

STATE BOARD QUESTIONS AND ANSWERS 

By JOHN FOOTE, M.D., Assistant Professor of Therapeutics, Georgetown 
University Medical School, Washington, D. C. Second edition, revised. 
429 pages. 













A normal breast-fed baby. 





NUTRITION OF 
MOTHER AND CHILD 


BY 

C. ULYSSES MOORE, M.D., M.Sc. (Ped.) 

INSTRUCTOR IN DISEASES OF CHILDREN, UNIVERSITY OF OREGON MEDICAL 
SCHOOL, MEDICAL DIRECTOR OF THE COOPERATIVE INFANT WELFARE 
SOCIETY OF OREGON, PRESIDENT NORTH-PACIFIC PEDIATRIC 
SOCIETY, PEDIATRIST TO THE MULTNOMAH COUNTY 
HOSPITAL AND THE FLORENCE CRITTENDEN 
HOME, PORTLAND, OREGON 


INCLUDING MENUS AND RECIPES 

BY 

MYRTLE JOSEPHINE FERGUSON, B.S., 
B.S. IN H.Ec. 

PROFESSOR OF NUTRITION, IOWA STATE COLLEGE, AMES, IOWA 
WITH 33 ILLUSTRATIONS 

SECOND EDITION, REVISED 



PHILADELPHIA AND LONDON 
J. B. LIPPINCOTT COMPANY 






1^3 2. !U 


COPYRIGHT, 1923, BY J. B. LIPPINCOTT COMPANY 
COPYRIGHT, I 924 , BY J. B. LIPPINCOTT COMPANY 



PRINTED BY J. B. LIPPINCOTT COMPANY 
AT THE WASHINGTON SQUARE PRESS 
PHILADELPHIA, U. S. A. 


JUL19 74 


©C1A800207 

Aa o | 


TO MY WIFE, 

WHOSE INTEREST AND ASSISTANCE 
HAVE RENDERED ITS COMPLETION POSSIBLE, 
THIS BOOK IS DEDICATED. 



PREFACE 


During the past decade, and especially dur¬ 
ing the past five years, important discoveries 
in nutrition have been made which have revolu¬ 
tionized our ideas of dietetics. Constant 
requests from mothers, librarians, social work¬ 
ers and nurses for books containing these newer 
facts of nutrition presented in a form suitable 
for the laity, has led the author to feel the 
necessity for this volume. 

The ideas here presented are not such as 
are advanced by faddists who, without occasion, 
advocate some erratic and unbalanced ration, 
but are facts of nutrition accepted by schools 
of accredited standing everywhere. 

The author has personally superintended 
various experiments corroborating or supple¬ 
menting the work of others along these lines, 
and the results thus obtained have been success¬ 
fully applied in clinical practice. Emphasis has 
been placed upon breast feeding, vitamins, and 
the mineral content of the diet. In the chapters 
on breast feeding, nothing is included which has 
not been tested and proven of practical value in 
personal experience. 

The sick child has been only casually con¬ 
sidered, as this volume is not intended to replace 
the physician in the home. In all illnesses, acute 
or chronic, medical advice should be sought. 
The purpose of the book is to teach mothers how 
to render their families less subject to disease. 

7 


8 


PREFACE 


As prevention is better than cure, our ideal 
should be the avoidance of unnecessary ills by 
proper diet from infancy. The author sends 
forth this little book with the hope that it 
may be of assistance to anxious mothers who 
are seeking to feed their families intelligently 
and scientifically. 

As the subject matter has been designed pri¬ 
marily for persons without medical training, 
the language employed has been made as untech- 
nical as is feasible in the presentation of scien¬ 
tific facts. The book has been so arranged that 
it may be employed by nurses and social workers 
for instruction of mothers in the homes, and in 
conducting short courses in nutrition. 

For his initial interest in breast feeding and 
much of his knowledge of the subject, the author 
wishes to express his indebtedness and grati¬ 
tude to his friend and teacher, Dr. Julius Parker 
Sedgwick of the University of Minnesota. For 
many of the scientific facts here presented, use 
has been made of recent publications by Dr. 
Alfred F. Hess and Dr. E. Y. McCollum of this 
country, and by Dr. J. C. Drummond, Dr. 
Edward Mellamby, and Dr. E. T. King of Eng¬ 
land; also of current publications in scientific 
and medical journals of both countries. For 
suggestions on the subject matter regarding 
teeth, the author is indebted to Dr. Percy P. 
Howe of Boston and Dr. Guy A. Woods of 
Portland, Oregon. 

December 29,1922. 


FOREWORD 


This text book for young mothers, and for 
social workers and nurses who have to advise 
them, is rich in the three vitamins: Scientific 
temper, common sense, and that sense of reality 
which comes naturally from a large specialized 
medical practice. Like the three known vita¬ 
mins of the author’s third chapter these essen¬ 
tial elements are not to be weighed or measured. 
They are not mechanically separable. If they 
are present in our mental diet we thrive on it. 
We digest and assimilate it. We relish and 
enjoy it. 

The scientific temper, which is not to be con¬ 
founded with indigestible accumulations of 
facts, protects the author and the reader against 
gullibility and also against the sterility of the 
closed mind. It insures holding fast to the 
older knowledge, such as is summarized in the 
first chapter. It inoculates against the errors 
of vegetarian enthusiasm and at the same time 
rejects the old errors, such as that drinking 
water is dangerous in measles, typhoid and 
other fevers. The special contribution of this 
first vitamin however, this scientific Soluble A, 
as we might call it, is to put the newer knowledge 
of nutrition in its right relation to other know¬ 
ledge and the practical needs of mothers and 


10 


FOREWORD 


infants. Here in a few pages we have the estab¬ 
lished and applicable results of modern re¬ 
search into the accessory food factors. It is 
fascinating; and it is not fantastic but directly 
useful. The past ten years have given an 
opportunity to see the sad effects of inadequate 
war diets on children. Dr. Moore had an unus¬ 
ual opportunity in Italy and in France to study 
and to counteract these deficiencies. He has had 
further opportunity in his private and hospital 
practice and in “well-baby clinics” of the Co¬ 
operative Infant Welfare Society of Oregon, to 
push such studies and to coordinate his obser¬ 
vations with the results of the researches of 
Funk, McCollum and others. A conservative 
but open minded scientific temper has made 
these opportunities fruitful to the advantage 
of the mothers who may read and study or hear 
at second hand what he has to tell them. 

The second vitamin, what we may call Com¬ 
mon Sense Soluble B, comes by nature. Neither 
university study nor experience by themselves 
will conjure it into those who do not have it. 
The absence of it is fatal and its presence is 
not difficult to detect. It guards against fads and 
exaggerations. It is an ally of the scientific tem¬ 
per and is very useful in the laboratory, but 
unfortunately it is sometimes left out of the 
academic diet. If it had not been present here, 
Dr. Moore would hardly have devoted a whole 


FOREWORD 


11 


chapter and innumerable incidental references 
to the subject of breast feeding . This is indeed 
his central and indispensable message. Others 
have advised it and some have emphasized it. 
Dr. Moore insists upon it, and what is more to the 
point, he shows that it is possible for every 
mother. He has a technique for it. The 
chapter on this subject, while amply forti¬ 
fied by science, morals and the experience of co¬ 
operating patients, whether prosperous or of 
restricted means, will be recognized as the very 
embodiment of common sense. 

The third imponderable factor in this treat¬ 
ment of the nutrition of mother and child is in 
some respects the most reassuring and indis¬ 
pensable of all. We may call it the sense of 
reality Soluble C. We do not read far without 
seeing that this is not merely a scientific report 
for specialists. Dr. Moore has indeed experi¬ 
mented for himself. He is thinking however 
not of his rats and puppies, but of the mothers 
and children whom he has known in their homes, 
in his consultation office and clinics. We 
see, too, that he has not relied on his common 
sense unduly. His mind is turned outward on 
realities, not inward on possibilities. Nothing 
is here merely because it is in books or has been 
projected by some academician. What appears 
here has to do with the life and health of 
mothers and babies. What is offered to us is 


12 


FOREWORD 


a diet, appetizing, digestible, balanced in essen¬ 
tial information, old and new, not over sea¬ 
soned, free from faults and fallacies; in other 
words, one that can be whole-heartedly recom¬ 
mended to all who are or ought to be interested 
in the welfare of mothers and children. 

Edward T. Devine. 


New York. 


INTRODUCTION 


For a generation past physiology and 
hygiene have been taught in our schoolSo As 
a result the average mother has a general under¬ 
standing of the physical needs of her child. She 
knows that he must have fresh air; that if he is 
confined in close, stuffy rooms he soon pales 
and sickens. So much has been said and pub¬ 
lished as to the benefits of fresh air that the 
screened sleeping porch is a common sight. 
Exercise, too, has come in for its share of 
emphasis. Even the infant is usually taken 
out for an airing and is given some sort of play 
time each day. The hours in the school room 
have been shortened that the children may have 
more time for play and relaxation. The normal 
child scarcely needs to be urged to exercise; 
rather the reverse is true. A mother usually 
must curb her child in this respect, or he will 
exercise to exhaustion. Proper cleanliness of 
person and clothing has received much attention 
of recent years. With modern facilities for 
bathing, there are few children in the average 
home who are neglected in this respect. Both 
dress reforms and improved housing conditions 
have had an influence in bettering the physical 
health of our children. 

Not denying the urgency of the foregoing, 

13 


14 


INTRODUCTION 


factors, nutrition surpasses in importance all 
other health considerations, and is the one in 
which failure is most common. One-fifth of all 
deaths occur during the first year of life, and 
more than half of these are directly due to 
nutritional disturbances. Not only is this true, 
but death in later life is so often traceable to 
improper feeding in childhood that we cannot 
afford to ignore the value of proper nutrition. 

Many mothers who realize the necessity of 
a well-balanced and properly regulated diet, 
do not comprehend what constitutes such a diet. 
This is not surprising when we consider the 
rapid progress recently made in nutritional 
knowledge. A study of food factors and the 
metabolic requirements of the human body is 
here presented, beginning with the old, long 
established facts of nutrition, and coordinating 
with these the newer discoveries of recent years. 


Introduction 


CONTENTS 


I. Former Knowledge of Nutrition. 19 

II. Newer Nutritional Knowledge . 26 

III. The Three Known Vitamins. 31 

IV. Rickets. 48 

V. Diet during Pregnancy and Lactation. 59 

VI. Breast Feeding. V . 73 

VII. Development of Breast Milk. 96 

VIII. Care and Feeding of the Premature Infant . 116 

IX. Diet from Six to Twenty-four Months. 124 

X. Artificial Feeding. ?. .. 142 

XI. Diet for the Older Child. 157 

XII. Faulty Diets. 177 

XIII. Some Common Fallacies in the Care and Feed¬ 
ing of Children. 189 

Appendix, .. 203 

Index . 228 


15 



























ILLUSTRATIONS 


FIG. PAGE 


A normal breast-fed baby. Frontispiece 

1. Showing the effect of a diet lacking the B vitamin.... 42 

2. The “young robin belly” in a rachitic bottle-fed child 48 

3. Impression of the mouth of a child of six years; 

Impression of the mouth of a child of seven years.. 48 

4. Badly bowed legs in a rachitic child two years of age 51 

5. X-ray of rachitic bow-legs. 51 

6. X-ray of forelegs of a puppy that received butter. ... 54 

7. X-ray of forelegs of a puppy receiving a commercial 

vegetable fat. 54 

8. X-ray of rats illustrating the superiority of butter 

over a commercial vegetable fat. 55 

9. Skull of a Mexican child seven years of age. 68 

10. Overlapping, irregular teeth, with malocclusion. 68 

11. Chart showing deaths per week during an entire year 

in Paris. 77 

12. Illustrating two methods of feeding and the death¬ 

dealing effect of artificial foods. 78 

13. a. Twins, three years of age. 79 

13. b. Impression of teeth of twins shown in Fig. 13,a. ... 79 

14. Normal variation in development of lactating breasts 88 

15. Abnormal variation in the size of the two breasts when 

only one is nursed. 88 

16. Accurate scales for weighing babies. 89 

17. Another type of accurate scales. 89 

18. Illustrates the movements needed to force milk out of 

the pockets in which it collects.. 98 

19. Diagram showing the method of expressing milk. 98 

20. First position in the expression of milk from a large 

pendant breast. 100 


17 

















18 


ILLUSTRATIONS 


FIG. 


PAGE 


21. Second position, showing compression of the 


breast 


between thumb and fingers. 

22. Second position, showing the thumb and forefinger press¬ 

ed deeply into the breast. 

23. Child of six weeks suffering from starvation due to 

mother’s spastic nipples. 

24. Child shown in Fig. 23, is here seen as a husky, breast¬ 

fed youngster of ten months. 

25. Breast-fed child of three months slowly starving from 

insufficient nourishment, due to weakness of suction. 

26. Same child shown in Fig. 25 after three months of 


100 

101 

107 

107 

108 


breast development. 108 

27. Breck Feeder. 121 

28. X-ray of baby showing swelling under the periosteum 

of the bone. 146 

29. Same case as in Fig. 28, showing a scurvy swelling above 


left knee. 146 

30. Comparative growth curves of a litter of rats fed on 

different breakfast foods. 161 

31. Impression of a child’s mouth in which the temporary 

teeth were allowed to decay. 168 

32. Boys dressed in trunks and sandals playing in the 

snow. ISO 

33. Impression of child’s mouth showing the irregular, pro¬ 

truding teeth and receding chin, due to thumb-sucking 
and early loss of first molars. 190 














NUTRITION OF 
MOTHER AND CHILD 


CHAPTER I 

FORMER KNOWLEDGE OF NUTRITION 

In a brief review of the history of nutrition 
it is hardly necessary to discuss the physiology 
of digestion or assimilation of food. The pro¬ 
cess of converting food into body materials is 
called metabolism. All foods contain one or 
more of the five main elements, protein, fats, car¬ 
bohydrates, salts, and water, each of which has 
its distinctive part in the work of metabolism. 

The Food Elements. Fuel Factors. —Carbo¬ 
hydrates, in the form of sugars and starches, 
form a large part of our diet and have two uses 
in the body: they produce heat and are stored 
up as a reserve food. The preponderance of 
carbohydrates in the diet is justified by the ease 
with which they are digested and assimilated by 
most individuals. The function of fats and oils 
in nutrition is very similar to that of carbohy¬ 
drates—both serve as fuel for heat and energy 
and both are a source of body fat. Though the 
consumption of carbohydrates is larger, the heat 

19 


NUTRITION OF 


20 

value of a unit weight of fat is much greater. One 
of the chief differences is that fat may be depos¬ 
ited in the animal without material change, 
whereas carbohydrates must undergo complex 
transformations before appearing as fat. How¬ 
ever, fats and carbohydrates are essentially the 
same in their chemical processes and uses in 
the body. 

Phot kin.— Protein is the food element that 
furnishes the material with which to build new 
body tissue and repair old tissue. The muscles, 
connective tissues, skin, and the tissues of the 
various organs, are largely formed from the 
protein of our foods. Hence, we see how impor¬ 
tant a part of our normal diet is this element 
and how erroneous is the idea presented by 
some vegetarian enthusiasts that animal food 
is unnecessary. Many plants, such as peas and 
beans, contain small quantities of protein in 
some of its forms, but our best sources of this 
necessary food are in milk, meat, and eggs. 
Gelatin and zein are proteins which are not capa¬ 
ble of yielding structural material because they 
are incomplete, that is, they lack some of the 
constituents that are necessary to form complete 
proteins suitable for the formation of body 
structures. Like fats and carbohydrates, pro¬ 
tein also has a heat-producing function. Per¬ 
sons living in an Arctic climate subsist largely 
upon meats and fats, and succeed in being very 


MOTHER AND CHILD 


21 


comfortable even in the coldest weather, 
whereas, on a vegetable diet, they could never 
withstand the rigors of their native land. On 
the other hand, those living in a torrid climate, 
where an excess of body heat is undesirable, 
and where great energy of body muscles is not 
required to procure a livelihood, subsist almost 
exclusively on a plant diet. We of the temper¬ 
ate zones find that a combination of animal and 
vegetable foods is best suited to our needs with 
more meat in winter and less in summer. 

Minerals. —A fourth and very necessary 
food element is that of minerals or salts. The 
tissues, blood, digestive fluids, and especially the 
bony framework of the body, contain large 
amounts of various minerals. For instance, 
phosphorus and lime are requisites for the for¬ 
mation of bone; iron is necessary to form the 
haemoglobin of the blood. Children fail to develop 
if given no mineral food and adults become 
weak, nervous, and inactive. Minerals are espe¬ 
cially important to the pregnant and nursing 
mother, that her child may develop healthy tis¬ 
sues, strong bones, and a stable nervous system. 
Those on a mixed diet rarely suffer from mineral 
deficiency, as there are various mineral salts in 
milk, meats, and cereals, while the ever neces¬ 
sary iron is abundant in the yolks of eggs and 
green vegetables. 

Water. —One of the most important elements 


22 


NUTRITION OF 


in nutrition is water. A person will die of thirst 
long before hunger becomes fatal. A large part 
of the tissues, as well as the fluids of the body, 
are composed of water; in fact, it comprises 
from one-half to two-thirds of the body weight. 
Water acts as a solvent for the building mate¬ 
rials, as a carrier of food from one organ to 
another, and as a remover of waste products. 
The last is accomplished through the skin, lungs, 
bowels and kidneys. 

Water in Disease .—However great the 
need of water in health, the demand is vastly 
increased during disease. There are then more 
waste materials to be removed; the temperature 
is higher, causing an increased evaporation 
from the skin; and the loss of water through 
the bowels is frequently increased. These addi¬ 
tional demands make it imperative to increase, 
rather than to decrease, the amount of water 
taken. At least fifty per cent, of the usual 
amount should be added to the normal daily 
intake in case of severe diarrhoea; in high fevers 
the amount should be twice that given in times 
of health. In former times it was believed to 
be almost fatal to give water in measles, typhoid, 
and other fevers. Now we know that these old- 
time beliefs and fears were without scientific 
foundation, and that many diseases are best 
combated with an abundant supply of water. 
Among these are included pneumonia, acute 


MOTHER AND CHILD 


23 


digestive disturbances, various fevers, and even 
common 4 ‘ colds. ’ ’ Frequently headaches, espe¬ 
cially those due to indigestion, biliousness, or 
insufficient exercise, may be speedily relieved 
by drinking one or two pints of lukewarm water. 
This results in no injury to the body, such as is 
often occasioned by the use of drugs, but is a 
positive benefit to the system in general. Water 
may and should be given, even when other foods 
must be withheld. 

Calories.—Every food contains one or more of 
the elements enumerated above. All of them 
are necessary, and no diet should consist of 
excessive amounts of any one element to the 
exclusion of others. Chemists have experi¬ 
mented elaborately and painstakingly with 
various foods until they have evolved lists repre¬ 
senting the value of each article of diet to the 
human body in the language of calories. A 
calory is the unit of measurement used to indi¬ 
cate the amount of heat or energy derived from 
a certain quantity of food. Calories thus serve 
to represent the value of foods from the energy 
standpoint. An article of diet high in caloric 
value, such as butter, is capable of maintaining 
life much longer than an equal amount of a food 
which is of low caloric value, such as tomatoes. 
About 1840, the famous chemist, Liebig, 
advanced the theory that the essential constit¬ 
uents of an adequate diet were proteins, fats, 


24 


NUTRITION OF 


carbohydrates, certain mineral salts, and water. 
Others have taught that calory values, protein 
content, and digestibility are the three nutri¬ 
tional factors which should determine our choice 
of food stuffs. 

Value of Calobies. —Calories have been con¬ 
sidered of such importance that, until recently, 
a large part of the attention given to diets in 
household science courses was centered upon 
the caloric value of food. To the ordinary 
mother, busy with her manifold duties, these 
caloric calculations seem so cumbersome and 
ultra-scientific that they have never been popu¬ 
larly used. The human appetite, as a rule, is 
a sufficient index to the needed amount of food 
for the energy requirements of the body. It 
is only in the case of some unusual condition, 
such as an undernourished child or an over¬ 
weight adult that particular attention need be 
given to caloric valuations. Carefully com¬ 
puted problems in diets have evolved estimates 
of the caloric requirements for adults and for 
children at various ages. In estimating the 
food allowances of children, both the size and 
age must be considered; for instance, an eight 
year old boy who is very large for his age may 
require as much food as a twelve year old of 
normal size. A detailed list of the caloric val¬ 
ues of common foods is given on page 203. 


MOTHER AND CHILD 

Daily Food Allowance for Healthy Children. 


25 


Age 

Years 

Boys 

Weight 

Pounds 

Calories 

Weight 

Pounds 

Girls 

Calories 

2 

27 

1000 

26.4 

1000 

3 

32 

1200 

30.5 

1100 

4 

36 

1300 

34 

1200 

5 

41 

1400 

40 

1300 

6 

45 

1500 

43 

1400 

7 

49 

1600 

47.5 

1500 

8 

54 

1700 

52 

1600 

9 

59 

1800 

57 

1700 

10 

65 

1900 

62 

1800 

11 

70 

2100 

69 

1900 

12 

•77 

2300 

78 

2000 

13 

85 

2500 

89 

2100 

14 

95 

2700 

98 

2200 

15 

107 

2900 

106 

2300 

16 

121 

3100 

112 

2400 


Mother 

35 135 2600 


Father 

40 154 


3500 






CHAPTER II 


NEWER NUTRITIONAL KNOWLEDGE 

The preceding chapter gives, in brief, the 
substance of our knowledge of nutrition prior to 
a decade ago. Useful as this knowledge is, we 
have discovered that there are other factors in 
nutrition just as important as calories. One 
may partake of protein, fats, carbohydrates, 
minerals, and water in adequate amounts and 
proper proportions and yet die of starvation. 
We wonder why the scientific world was so slow 
in discovering that protein values, calories, and 
digestibility are not the complete story of nutri¬ 
tion. The reason probably lies in the fact that 
that part of the world in which scientific research 
flourishes has usually consumed such a widely 
varied diet. The existence and the importance 
of certain factors normally present in such a 
diet, long failed to be appreciated. 

Vitamins. —For years, ardent students of the 
subject had felt that the chemists were at fault 
in believing that they could fully determine the 
value of foods by chemical analysis. In 1911, 
Funk crystallized these ideas and shattered our 
former beliefs of nutrition by announcing his 
theory of vitamins. He held that in our food 
there are certain minute substances of unknown 

26 


MOTHER AND CHILD 


27 


composition which have not, as yet, been chemi¬ 
cally separated or analyzed, but which exercise 
a very marked influence upon nutrition. To 
these he gave the name “vitamin.” About the 
time Funk announced his belief in the exis¬ 
tence of vitamins, McCollum and his coworkers, 
at the University of Wisconsin, brought forth 
further scientific proof of the accuracy of 
this theory. 

The Tale of The Calves. —Have you heard 
the story of McCollum’s calves! It reads like 
a fairy tale. In the year 1906, three groups of 
heifer calves were selected and placed on diets 
chemically equal; the fat, protein, and carbohy¬ 
drate contents of the three were identical as 
were, consequently, the caloric values. One 
group was fed on corn, another on oats, and the 
third on wheat—the complete plant, stalk, 
leaves, and kernel being used in each case. The 
calves grew and thrived and only minor differ¬ 
ences were noted until they were grown and pro¬ 
duced young. The cows that had been fed on 
a wheat diet from babyhood produced calves 
that were born dead and weighed only 40 to 50 
pounds, while a normal calf at birth weighs 
from 75 to 80 pounds. The oat-fed cows 
brought forth calves practically normal in 
weight, but these were also born dead. The 
corn-fed cows produced calves that were normal 
in weight and that were on their feet within a 
few hours. Considered from a casual point of 


NUTRITION OF 


28 

view, these results would seem to indicate the 
superiority of corn above other cereals. The 
real point of advantage lay in the larger amount 
of green leaves and stalk in the corn diet, rather 
than in the grain itself. This point will be en¬ 
larged upon later. 

A New Era. —When the results of these 
experiments were published, the eyes of the 
world were opened to amazingly wonderful facts 
in the science of nutrition and a new epoch in 
dietetics was entered upon. We came to realize 
that a diet may be chemically complete and yet 
be wofully inadequate for proper growth, devel¬ 
opment, and reproduction. Since this elaborate 
undertaking was completed, many scientists 
have conducted other dietetic experiments, using 
smaller animals such as mice, rats, dogs, guinea- 
pigs, and pigeons. The smaller animals are 
preferred, both because of the lesser expense 
involved and because the cycle of growth, 
maturity, and reproduction is completed in a 
much shorter time. Practically every medical, 
chemical, and nutritional institution in the 
country is now conducting experimental studies 
in vitamins. 

Each year new facts are being established, 
and we cannot but feel that our knowledge of 
these accessory food factors is still in its infancy. 
During the past few years the sad experiences 
resulting from inadequate war diets have also 
been a means of changing many beliefs and 


MOTHER AND CHILD 


29 


theories. This has led to an intensive study of 
infant morbidity and mortality from the stand¬ 
point of nutrition. So surprising have been the 
results of all these recent experiments that our 
former mathematical calculations of food values 
have been proven altogether inadequate. 

Vitamin Knowledge .—There are so many 
points about which we are, as yet, uncertain that 
we sometimes feel our knowledge of vitamins 
is very meagre; however, we do know some of 
the essentials. One of the peculiar facts about 
vitamins is the disproportion between their 
great importance and the very insignificant 
amounts in which they are consumed. They 
are present in amounts far too small to add to 
the energy supply of the body. Scurvy, that 
dread disease known for centuries among sea¬ 
faring men, can be wholly prevented by the 
daily addition to a sailor’s diet of three or four 
tablespoonfuls of orange or lemon juice. These 
fruits owe their efficacy to the vitamin they 
contain. Whether these minute amounts of 
vitamins are necessary foods themselves, or 
whether their presence merely helps other food 
to become effective we do not as yet know, nor is 
it positively necessary that we should know this. 
We know that the body is extremely sensitive 
to certain substances existing in natural food¬ 
stuffs in minute quantities; and that if these 
substances are destroyed or removed, such foods 
fail to support nutrition, and actual grave dis- 


30 


NUTRITION OF 


ease may result. Our modern desire to have all 
food perfectly sterilized, and our present day 
methods of preservation of various foods, are, 
in many instances, responsible for the destruc¬ 
tion of these necessary substances. Vitamins in 
some form are always present in natural foods, 
and any individual will have a sufficient supply 
of these essential factors as long as his diet is 
sufficiently varied and has had no destructive 
influences applied to it. 

The reader may say, “ Since my family has 
a varied diet, do they not receive these vitamins 
in different foods V 9 They may and they may 
not. Many persons have idiosyncrasies of taste 
that lead to a very unbalanced ration; sometimes 
limited means is an influencing factor ; and very 
often children consume a scanty variety of 
foods, even where an abundance is provided 
upon the family table. Also, while an individual 
may receive enough of a given vitamin to pre¬ 
vent actual disease, it may be in amounts far 
too small to promote proper nutrition and to 
insure good health and longevity. This is par¬ 
ticularly true in the case of young children, as 
their vitamin requirements are far greater than 
those of adults. Even a partial deficiency of 
one or more of these necessary food substances, 
occurring in early childhood, may lead to 
extremely serious results; and these ill effects 
cannot be repaired, even by excessive amounts 
taken in adult life. 


CHAPTER III 


THE THREE KNOWN VITAMINS 

At present there are three vitamins recog¬ 
nized as necessary for health, proper growth and 
normal development. For want of knowledge 
as to their chemical nature, they have been desig¬ 
nated by the first three letters of the alphabet. 
One of these accessory food factors, found in 
animal fats and in green leaves, is called the A 
vitamin or fat-soluble A. Another, called the B 
vitamin or water-soluble B, is found in the seeds 
of plants, in egg yolks, and in many fruits and 
vegetables; a third one, termed water-soluble 
C, is also found in most juicy fruits 
and vegetables. 

Fat-soluble A. —This vitamin has its original 
and natural source in the vegetable kingdom— 
the green leaves of plants. Its presence in ani¬ 
mal foods is due to the fact that the animals 
which produce this vitamin have first obtained 
it from plants that furnish their diet. The 
fat-soluble factor was first detected in butter, 
cod-liver oil and egg-yolk, and these are still 
considered the richest sources of this vitamin. 
It may vary in amount in animal foods at differ¬ 
ent seasons according to the amount of green 
food the animal has been consuming. A cow 
that has been fed for some time entirely on hay 

31 


NUTRITION OF 


32 

and grain produces butter-fat of a lesser vitamin 
content than when green grass or other fresh 
food has formed a part of her diet. In children, 
many of the symptoms arising from deficiency 
diets appear in late winter or early spring, when 
both animal and vegetable foods are lowest 
in this necessary factor. The well-known crav¬ 
ing for green foods in the early spring is the 
call of the body for its necessary quota, 
of vitamins. 

Animal and Vegetable Sources. —The fat- 
soluble vitamin is present in a variety of foods 
of daily use, and no individual in ordinary cir¬ 
cumstances need be without it. Since butter 
is one of its richest sources, every child should 
have an adequate amount each day. This 
should be fresh and unheated. If there is a 
limited amount of butter available in the family, 
it should be given to the children, even though 
the adults have to refrain from its use. Chil¬ 
dren are much more sensitive to a deficiency diet 
than their elders, who have completed their 
growth. Fish oils, from cod, cod liver, salmon, 
and whale, are also satisfactory sources of this 
substance. Oleomargarine made from animal 
fats contains the A-vitamin in lesser amounts 
than butter, but nut margarines made from vege¬ 
table oils are lacking in this substance. The 
glandular organs of animals such as liver, kid¬ 
neys, heart and sweetbreads, represent a much 
richer source of fat-soluble A than do the mus- 


MOTHER AND CHILD 


33 


cular portions of the animal which we more 
generally consume. Pork fat seems to be almost 
wholly deficient in this factor. In the vege¬ 
table kingdom, spinach, carrots, peas, and green 
leaves contain varying amounts. Yellow corn 
contains some, but white corn is considered val¬ 
ueless as a source of the A vitamin. Corn, 
olive, and cotton-seed oils have been shown to 
be deficient in this respect. 

Water-soluble B.— Experiments have demon¬ 
strated that egg-yolk, cereals, spinach, cabbage, 
carrots, onions, beets, tomatoes, and certain 
other vegetables contain the B vitamin. The 
germ of the grain, rather than the bran, as was 
formerly supposed, is one of the most potent 
sources of this factor. The germ is usually 
removed with the bran as ‘ ‘ shorts ’ ’ and is used 
as stock food. Thus, we feed the growth-promo¬ 
ting portions of our grains to our animals and 
give the lifeless starch to our children. Com¬ 
mercial bran, sold by grocers to be added to 
refined cereals, is not of much vitamin value as, 
usually, the germ has been removed. Whole 
grain products should constitute a large part of 
our cereal consumption, and would do much to 
correct the faulty diets of our children. The 
water-soluble B is more often lacking in 
our dietaries than the fat-soluble A. This 
is especially true among children, who fre¬ 
quently dislike vegetables and prefer white 
bread and refined or prepared cereals 
to the whole grain products, One of the rich- 

3 


34 


NUTRITION OF 


est known sources of the B vitamin is ordinary 
yeast. This is often prescribed in the diet of 
weak or nervous children, frequently with mar¬ 
velous results. However, promiscuous con¬ 
sumption of yeast has become a fad, and is to 
be discouraged, except under a physician’s di¬ 
rection. Next to yeast rank whole grain cereals 
and egg-yolk. These latter should be included 
in all well-balanced diets. 

Milk is not an abundant source of water- 
soluble B and, hence, milk and white bread, upon 
which many children largely subsist, is far 
from a complete or satisfactory diet. 

Water-soluble C. —The C vitamin is an essen¬ 
tial of every individual’s diet, but is frequently 
lacking in the food of young children under two 
years of age. Its presence has been determined 
in most fruits and green vegetables, less in root 
vegetables. It is found in small amounts in 
meat and milk, but has not been detected in 
yeast, fats, or cereals. Orange, lemon, tomato, 
and raw cabbage juices are the richest sources 
of this vitamin. 

Cabbage Juice .—Dr. Harriette Chick of Lon¬ 
don has recently demonstrated the very interest¬ 
ing and practical fact that raw cabbage juice 
is fully as effective as orange juice. Since the 
relative cost of cabbage is very small compared 
with that of oranges, hers is a most important 
discovery. A half cup of cabbage, put through 
the food grinder and then compressed in a cheese 


MOTHER AND CHILD 


35 

cloth, will yield from one to two ounces of juice. 
Naturally, only for infants is it necessary to 
express the juice; older children may eat the raw 
cabbage, whole or finely chopped, according to 
age. The juices of raw turnips, beets, and 
carrots are likewise good sources of the C vita¬ 
min. Mothers should see that their families 
receive this substance every day in some form. 

Destructive Influences.— Cooking or drying of 
foods has a distinct influence on the vitamin 
content. Butter that has been heated for four 
hours at 100 degrees largely loses its growth 
promoting qualities, and even after one hour 
these are distinctly lessened. Prolonged heat¬ 
ing is more harmful than a higher degree of 
heat for a shorter time. Reheating foods after 
they have once been cooked produces a further 
diminution of the vitamin efficiency. Dried foods 
are very poor in vitamins, especially those 
which have been subjected to a slow process of 
drying. Storage also has a markedly destructive 
influence. The B factor is the most stable one 
and is least affected by drying. The C vitamin 
is the least stable, and hence suffers most 
from these processes of preservation. Cook¬ 
ing or drying largely destroys this impor¬ 
tant factor. Exceptions to this rule are 
in the case of potatoes, if large quantities are 
used, and tomatoes, which are so rich in this 
factor that they retain goodly amounts of the 
water-soluble C, even after being canned and 


36 


NUTRITION OF 


reheated. A general rule is that more cooked 
food is required to supply a sufficiency of vita¬ 
mins than is necessary when the same food is 
eaten raw. Arctic explorers have found that in 
the absence of fresh fruits and vegetables, 
scurvy can be prevented by the eating of raw 
meats, whereas, if all the meat is cooked, scurvy 
almost invariably develops. This eating of raw 
meats, permissible in Arctic lands, would not be 
advisable in warmer countries, because of the 
danger of bacteria. Foods should be as fresh as 
possible and not previously heated. All pre¬ 
pared cereals and many uncooked varieties have 
been subjected to heat in the processes of milling 
and sterilization. This, followed by storage and 
aging, markedly diminishes the vitamin content. 
Whole grain cereals, unheated in milling, are in 
every way preferable. The very fact that the 
latter do not keep as well insures their 
greater freshness. 

All fruits and vegetables should be cooked 
as short a time as possible. No fresh vegetable, 
except green beans, needs to be cooked more 
than forty-five minutes, and for cabbage, fresh 
peas, new potatoes, spinach, asparagus 
Brussels sprouts, cauliflower, and new carrots, 
twenty to twenty-five minutes are entirely 
ample. Carrots, beets, and turnips should be 
sliced and finely chopped to shorten the time of 
cooking. Vegetables should be cooked in as 
small an amount of water as possible, none of 


MOTHER AND CHILD 


37 


which should be drained off. The cooking 
should be done just at the boiling point, not at 
a ‘‘ gallop, ’ 1 as the English term it. In making 
soups, the vegetables should be added only in 
time to insure their being tender, and cabbage or 
tomatoes should be added last. When root 
vegetables are old and tough they may be finely 
chopped, the juices pressed out, the pulp then 
cooked alone, and the juices readded just before 
serving. In this way the vitamin is less affected. 

DEFICIENCY DISEASES 

It has been very clearly demonstrated that 
there are distinct diseases associated with a lack 
of any of the vitamins. These can be induced in 
no other way and hence are termed ‘ ‘ deficiency 
diseases.” The affection may be so slight as to 
escape notice in cases of only a partial defi¬ 
ciency, or, in the case of a total deprivation, the 
disease may be so severe as to cause death. 

Eye Affections.— One of the most easily recog¬ 
nizable and clearly defined conditions caused by 
a lack of the fat-soluble A is an affection of the 
eyes known as xerophthalmia . In Roumania, 
during the war, Red Cross workers found the 
children living on a limited diet of corn meal and 
thin bran soup. No milk, butter, or green vege¬ 
tables were obtainable. Many were suffering 
with a severe eye affection—a congested con¬ 
dition of the lids with inflammation of the eye¬ 
ball. This often led to formation of pus, hem- 


38 


NUTRITION OF 


orrhages, and in severe cases to total blindness 
and death. A cargo of cod-liver oil was 
obtained through the American Red Cross, and 
with this food, rich in fat-soluble A, the disease 
was checked and many little lives saved. In 
fact, after only a few days on this vitamin-rich 
diet a vast improvement was noticeable in the 
severest cases of xerophthalmia. 

Animal Experiments. —Rats fed on a diet 
deficient in fat-soluble A first show the deficiency 
by a cessation of growth, then by a marked 
susceptibility to infectious diseases. Xeroph¬ 
thalmia soon results and can be cured only by 
the administration of a food rich in the A vita¬ 
min. Within a few days, and sometimes even 
within a few hours, after butter or cod-liver 
oil is added to the diet, the eye condition clears 
up. In a few days more growth recommences. 

Rickets. —A more common disease than 
xerophthalmia is that of rickets. This has been 
shown to be associated with a deficiency of 
vitamins. Rickets is of such importance and 
of such prevalence that it is considered in a 
separate chapter. 

The Age Factor.— The need of fat-soluble A 
is more imperative in children than in adults, 
though, the latter are by no means independent 
of this need. The younger the animal is when 
placed on a deficiency diet, the sooner he shows 
the effects of it, sometimes within a few days. 
It has been shown that mature young 


MOTHER AND CHILD 


39 


rats can live without fat-soluble A in fairly 
good health for a certain time, no doubt due to 
the fact that there are reserve stores in the 
tissues. Eventually, however, the deficiency is 
manifested by a loss of weight, eye affections, 
and a susceptibility to disease. Attention has 
been called to an eye condition in the men of 
the northern lumber camps known as “ night 
blindness.’’ This is believed to be due to a diet 
in which the only fat is cured bacon, which is 
practically free of any vitamin. 

Need of Water-soluble B. —The B vitamin is 
fully as important as fat-soluble A, and is more 
frequently omitted from the dietary. This vita¬ 
min has a distinct value in promoting growth. 
Without this factor in their diets, young ani¬ 
mals cease to grow and do not live long. This 
cessation of growth takes place almost immed¬ 
iately following the removal of the water- 
soluble vitamin as, apparently, the body holds 
little in reserve. Not only do the young cease 
to grow without water-soluble B, but both young 
and old rapidly lose weight and, unless the 
shortage is made good, the experiment termi¬ 
nates in death. Following a cessation of growth, 
the next symptom to be noticed is a lack of 
control over the nervous System. Chickens and 
pigeons, so fed, acquire a paralysis of the legs, 
and stagger about painfully as they try to walk. 
This affection is termed polyneuritis . 

Beri-beri.— The disease in man correspond- 


40 


NUTRITION OF 


ing to polyneuritis in fowls is called beri-beri. 
It is a severe nervous disorder occurring chiefly 
among the rice-eating peoples of the Orient. 
There is a great wasting of the body with pa¬ 
ralysis of the extremities, or there may be 
extreme swellings of the- trunk and limbs. The 
heart is usually involved, and in severe cases 
death may result suddenly from heart failure. 
The disease has been found to be due entirely 
to a lack of the water-soluble vitamin, which 
occurs when polished rice is used. Those 
Orientals who subsist almost exclusively upon 
rice, have no other source- of the B vitamin than 
the germ of this cereal. When the germ is 
removed in the process of milling, the disease 
characteristic of this deficiency results. Peo¬ 
ples who eat rice milled by hand, in which pro¬ 
cess the germ is not removed, do not contract 
beri-beri. Both in human beings and pigeons 
the disease may be checked, if it has not pro¬ 
ceeded too* far, by the administration of rice 
polishings or whole unpolished rice. Pigeons 
have been cured of polyneuritis within twenty- 
four hours after a return to a diet containing 
water-soluble B. 

White Bread. —A similar disease may be 
induced by a diet consisting largely of white 
bread. Mice fed on a diet of white flour 
and water do not live more than a week; those 
fed on whole wheat flour and water live a normal 
length of time. Dr. Harvey Wiley, former gov- 


MOTHER AND CHILD 


41 


ernment food chemist, is fully sustained by re¬ 
cent experimental knowledge in his wholesale 
denunciation of refined flours and cereals. Our 
only salvation lies in the fact that we have such a 
varied diet in America that other foods tend to 
make up the deficiency of our highly milled, 
beautifully white flour. However, a mother is 
wiser, both from the standpoint of vitamins 
and digesti&dlity, if she feeds her family on the 
more nutritious whole wheat bread and cereals. 

General Effects .—In animal experiments it 
has also been found that on a diet lacking the 
B vitamin the body temperature falls, indicat¬ 
ing a diminution in the activity of the tissue 
cells. Digestion is weakened and the various 
organs of the body decrease in weight. Among 
these the organs of reproduction suffer in a 
marked degree, the loss in weight of the testicles 
of the males reaching 93 per cent, in some cases. 
The ovaries of the females decrease in weight to 
as much as 69 per cent. Drummond, in England, 
found that after fourteen days on a diet lacking 
the B vitamin, rats lost their power of 
reproduction. 

Personal Experiments.—To test the effect of 
an absence of water-soluble B in the diet of ani¬ 
mals, we conducted the following experiments 
on rats. In each case the defective diet con¬ 
tained an abundance of fat, protein, carbohy¬ 
drates, salts, and water. 

Nubsing Period. —We found that when a 


42 


NUTRITION OF 


mother rat, immediately after birth of her 
young, was placed on a diet lacking the B vita¬ 
min, her offspring grew normally for a short 
time only. They then began to lose in weight 
and died in less than four weeks. This was 
true in each litter tested. 

After Weaning. —To test the effect of the 
B vitamin on animals after weaning, litters of 
young rats eight weeks old were used. Each 
litter was divided into two groups. The diets 
of all were exactly the same, except that one 
group had no water-soluble B, while the other 
group received yeast which is rich in this vita¬ 
min. Those having the B vitamin grew nor¬ 
mally, and in due time reproduced healthy 
young. Those on the deficient diet grew for a 
time, then declined in weight and the majority 
died within three months. The photograph in 
Figure 1 illustrates the comparative size of 
rats from the two groups. 

These two rats were from a litter of eight 
young, divided as indicated. The small one 
was the only surviving member of his group 
of four which received the deficient diet. He 
weighed but two and one-half ounces. His full 
brother, fed on the vitamin-containing diet, 
weighed over five ounces at the time the pic¬ 
tures were taken, twelve weeks after the begin¬ 
ning of the experiment. 

Reproduction .—Corroborative of the work 
of others were the results of our experiments 
when we mated normally fed males with the 







Fig. 1 . —Showing the effect of a diet lacking the B Vitamin. After three months on a deficient 
diet, the rat above weighed only two and one-half ounces, while his full brother, below, which 
had received the B Vitamin, weighed five ounces. 
































MOTHER AND CHILD 


43 


female rats who had lost their young because of 
vitamin deficiency. No pregnancies resulted; 
even after the females had been returned to 
a normal diet for a period of ten days, ster¬ 
ility continued. 

Human Experiences.— Human observations 
have demonstrated similar results. One author¬ 
ity found among the women in the Philippines 
suffering from beri-beri, that eighty per cent, 
of pregnancies resulted either in abortion or in 
death of the child during the first year of life. 
Many cases of sterility developed among the 
poorly nourished peoples of Belgium, Austria, 
and Germany during the war. This may have 
been attributable more to a generally deficient 
diet, than to a specific lack of the B vitamin. A 
few years ago, however, the idea that diet could 
in any way influence reproduction would have 
been considered absurd. We now feel that there 
is scientific foundation for the belief that many 
of our childless American homes may be such 
because of incomplete diets, either in childhood 
or adult life, on the part of the would-be parents. 

Scurvy.— The water-soluble C vitamin is of 
greatest importance in preventing scurvy. For 
centuries, this disease has been recognized, and 
its cure known to be orange juice. Recent 
experiments have demonstrated that it is a 
vitamin problem, and the number of curatives 
has been enlarged. Both children and adults 
are subject to scurvy. In the former, it is usu¬ 
ally due to the use of condensed, dried, or over- 


44 


NUTRITION OF 


heated milk. In adults it appears among men 
subsisting for long periods on dried or preserved 
foods, such as those in the army or navy or upon 
Polar expeditions. Likewise it appears in 
institutions where the diet is largely lacking in 
fresh fruits and vegetables. 

Symptoms. —The acute form of scurvy is 
characterized by hemorrhages of the gums, 
looseness or falling out of the teeth, swelling of 
the joints at wrists, knees, and elbows, great 
weakness, and a general soreness of the muscles. 
In infants, one of the first symptoms is fretful¬ 
ness and an indisposition to be handled or even 
touched: the child will cry at the approach of 
its mother, evidently f earing it is to be taken up. 
Usually associated with these symptoms, or 
preceding them, is an enlargement at the base 
of the heart, accompanied by rapid pulse and 
respiration. Mild cases of adult scurvy may 
manifest themselves only as languor and depres¬ 
sion, with vague pains suggestive of rheumatism. 
The mild or latent form of the disease may be 
suspected in an infant who is fretful, has a pale, 
muddy complexion, stationary weight, and loss 
of appetite. Such cases often fail of recogni¬ 
tion. Though they may never develop into 
acute forms, they cannot fail to have seriously 
deteriorating effects on normal development. 
It is to prevent the development of such condi¬ 
tions as this that regular examinations of infants 
and children are advisable. 


MOTHER AND CHILD 


45 


Cure of Scurvy.— As with all other deficiency 
diseases, so with scurvy, the cure lies in sup¬ 
plying the food factor, the lack of which has 
been the cause of the condition. In infantile 
scurvy, orange juice, tomato, or raw cabbage 
juice are easily given and work speedy cures. 
To demonstrate the almost miraculous results 
effected by this treatment it may be of interest 
to cite an individual case: The babe was eight 
months of age and weighed only ten pounds. 
For four months she had been fed on proprie¬ 
tary foods. At the first examination, her feet 
were found to be painful to touch, and she 
screamed with fright if anyone approached her. 
The respiration was short and quick, the pulse 
rate was 174. Four teaspoonfuls of raw cab¬ 
bage juice daily were prescribed. After two 
days she showed remarkable improvement, fol¬ 
lowed by rapid and complete recovery. Natu¬ 
rally, the mother marvelled at the seemingly 
magic effect of cabbage juice. 

Summary .—Fat-soluble A is necessary to 
insure in children proper growth, strong bones, 
and healthy tissues; in both children and adults, 
to maintain proper nutrition and render the 
body less susceptible to disease. 

Water-soluble B is necessary to furnish 
proper nutrition for the nerve tissues, to insure 
growth and normal development, and to main¬ 
tain the functions of the body organs, including 
those of reproduction. 


46 


NUTRITION OF 


Water-soluble C insures the body against 
the weakness and lassitude of latent scurvy as 
well as the graver results of the more serious 
forms. 

A mother should see that there is enough 
variety in her children’s dietary to insure a 
sufficiency of those foods containing these three 
necessary vitamins each day. Emphasis needs 
to be placed on the danger of overcooking foods, 
especially vegetables, and upon the advisability 
of taking daily some raw fruit or vegetable. 

The following table, giving the comparative 
vitamin values of certain foods, was compiled, 
with slight modifications, from one prepared by 
the English Government’s Medical Eesearch 
Committee. 


Fat-soluble 

Classes of Foodstuff A ZchitiS~ 
Factor 


Water-soluble B or 

Antineuritic Antiscorbutic 

(Anti beri-beri) Factor 

Factor 


Butter . + + + 

Cream . + + 

Cod-liver oil . + + + 

Mutton fat . + + 

Beef fat or suet... + + 

Fish oil, whale oil, 

etc. + + 

Lean meat (beef, 

mutton, etc.) -f- + 

Liver . + + + + 

Kidneys . + + 4* 

Heart . + + + 

Fish, fat (salmon, 

herring, etc.) .. -f- + very slight, if any 
Canned meats .... ? very slight 


+ 

+ 













MOTHER AND CHILD 


47 


Milk, cow’s, whole, 


raw . 

+ + 

+ 

+ 

Milk, skim, raw... 


+ 

+ 

Milk, condensed, 
sweetened .... 

+ 

+ 

less than + 

Cheese, whole milk 
Eggs (fresh) . 

+ 

+ + 

+ + + 

? 

Wheat, maize, rice, 

*■ whole grain .. 

+ 

+ 


Wheat germ . 

+ + 

+ + + 


Germinated pulses 
or cereals .... 

+ 

+ + 

+ + 

Cabbage, fresh 

(raw) . 

+ + 

+ 

+ + + 

Cabbage, fresh 

(cooked) . 


+ 

+ 

Swede (turnips) 
raw expressed 

juice. 

Lettuce . 

+ + 

+ 

+ + + 

Spinach . 

+ + 

+ + 

+ 

Carrots, fresh 

(raw) . 

+ 

+ 

+ 

Potatoes, cooked 
Potatoes, raw. 

+ 

+ 

+ 

+ 

Onions, cooked .... 
Lemon juice, fresh. 
Orange juice, fresh. 

Raspberries. 

Apples . 

Bananas . 

+ 

+ 

4- at least 
+ + + 

+ + + 

+ + 

+ 

very slight 

Tomatoes (canned) 
Nuts . 

+ 

+ + 

+ + 

Yeast (dried) .... 


+ + + 



None of the three factors were found in: Lard; olive, 
cottonseed, cocoanut, or linseed oils; cocoa butter; hardened 
fats, animal or vegetable in origin; margarine, from vegetable 
fats or lard; cheese, from skim milk; polished rice, white 
wheaten flour, pure corn-flour, etc.; custard powders, or egg 
substitutes prepared from cereal products, and meat extracts. 

















CHAPTER IV 


RICKETS 

Rickets, or rachitis as it is termed in medical 
parlance, is a disease of infancy or early child¬ 
hood which materially affects growth and devel¬ 
opment. Some authorities state that eighty per 
cent, of present day infants are affected by it. 
Rickets appears usually between the second and 
twenty-fourth months of life. After this age, 
the child who has thus far escaped rarely devel¬ 
ops the disease, though the evidences of its 
previous existence often persist throughout life. 

Symptoms. Nervous. —The first evidences of 
developing rachitis are of a nervous type, such 
as restlessness, peeidshness, fitful sleep, and a 
hypersensitiveness to touch. This is accompa¬ 
nied by a marked increase in perspiration; the 
pillow of a rachitic infant may be drenched 
during sleep, even in winter. 

Muscular.— Following the nervous evi¬ 
dences of rickets we find that the smooth muscle 
fibres stretch and become flabby, a condition 
first apparent in the abdomen. As the muscles 
of the intestinal walls dilate they force the 
abdominal wall outward, giving the round pro¬ 
truding abdomen, known as the “young robin 
belly.’’ Constipation ensues, followed in later 

48 



Fig. 2. —The “young robin belly” in a rachitic, bottle-fed child. The square, bulging 
forehead is also noticeable. (Courtesy, Dr. L. Howard Smith.) 



Fig. 3. —At left, impression of the mouth of a child of six years; deciduous teeth show 
inadequate separation. Arch is not widening and spreading sufficiently to make room for 
the much larger permanent teeth. At right, impression of the mouth of a child seven years, 
showing permanent incisors standing at an angle as a result of underdevelopment of the arch 
and jaws. 














MOTHER AND CHILD 


49 


life by chronic indigestion and dyspepsia, with 
all their accompanying ills. In many cases of 
adult colon trouble demanding surgical atten¬ 
tion, an inquiry into the early history of the 
patient reveals feeding difficulties and in¬ 
fantile rachitis. The heart muscle is also af¬ 
fected by rickets, becoming enlarged, with 
diminished power of accommodation to various 
forms of exercise. 

Bony. — A third manifestation of rickets, 
and the one most strikingly evident, is the effect 
on the bone formation, resulting from a dim¬ 
inution in the amount of calcium deposited. 
Practically all the framework of the body is 
affected. In the young infant the bones of the 
skull fail to harden as they should; the edges of 
the fontanelle soften, and the opening does not 
close until late in the second year; the frontal 
bones become decidedly thickened, causing the 
child to have a large and often misshapen head, 
with the forehead bulging and back of the head 
flat; or he may have a square or quadratic head 
with the edges more or less well defined. Of 
even more importance, as regards both physical 
beauty and sound health, is the effect on the 
jaw bones. The jaws become narrowed forcing 
the arch of the mouth upward, thus lessening 
the nasal space, and leading to adenoids with 
their pernicious consequences. The teeth are 
delayed and irregular in eruption, crooked and 
crowded in position, and in composition soft and 

4 


50 


NUTRITION OF 


non-resistant to decay. Not only are the tem¬ 
porary teeth thus affected, but the permanent 
ones are even more noticeably impaired. If 
the jaws fail to expand as the child approaches 
the age of six, even though the first teeth be 
fairly straight and strong, the permanent teeth 
are crowded into a space perhaps three-fourths 
as large as they should occupy. The misery 
caused, both directly and indirectly, by unsound 
teeth or malocclusion* is coming to be fully ap¬ 
preciated by the medical and dental professions. 
Many a child must of necessity undergo months 
of discomfort at the hands of the orthodontist 
and his parents pay large sums for the correc¬ 
tion of these deformities caused by early rickets. 

Trunk Deformities. —The disease leads to 
three types of deformed chests: flat, triangular, 
and square. In the first type of chest the front 
is flattened while the sides are rounded. Across 
the lower part of the chest a groove is usually 
present. In infants the ribs feel abnormally 
soft in front. The triangular chest is flat on 
each side and flares outward in front at the 
breast bone forming what is known as the 
“pigeon-breast.” The square chest is flat at 
the sides and in front with rather sharp cor¬ 
ners. With any of these deformities we usually 
find the well-known “rosary,” a row of hard 
bead-like formations on the ribs extending down¬ 
ward at the sides of the chest. The complica- 

* Failure of the teeth to meet properly for mastication. 





Fig. 4.—Badly bowed legs in a rachitic child two years 

of age. 


































Fig. 5.—X-ray of rachitic bow-!egs showing marked curvature just above ankles, and 
diminished calcium content above the knees, indicated by the semi-transparency of the 
bone, and by the indefinite margins of the bone-ends. 




MOTHER AND CHILD 


51 


tions that may develop from these malforma¬ 
tions are naturally those connected with the 
lungs, which are crowded downward in their 
position and hindered in their development. 
The child, thus affected, is often afflicted with 
nasal catarrh, bronchial inflammation, or res¬ 
piratory infections. Dr. Abraham Jacobi, the 
first child specialist in America, noticed many 
years ago that pneumonia and whooping cough 
are far more often fatal to the rachitic child. 

The pelvic bones share in the general 
deformity, being flattened and otherwise abnor¬ 
mal in shape. In the female child this may 
result in serious complications in adult life. 

Extremities .—The most commonly noticed 
malformations of the bones are those of the 
arms and legs. The joints at the wrists and 
ankles become thickened and enlarged. The 
long bones of the legs bend either inward form¬ 
ing knock-knees, or outward forming bow-legs. 
It is an interesting study at the bathing beach 
to note the characteristic horny knees and mis¬ 
shapen legs of the individual who bears about 
in his person the evidences of early rickets. 
The fingers, also, are thickened at the joints and 
lose their natural tapering appearance. 

A child may not exhibit all of these signs 
or symptoms and yet have a pronounced case 
of rickets; sometimes the limbs alone are 
affected, again the head or chest may show the 
leading defects. Whatever the visible evidences, 


52 NUTRITION OF 

the health and well-being of the child are, 
in some degree, permanently affected by 
the disease. 

Cause of Rickets. —During recent years dif¬ 
ferences of opinion have existed as to the cause 
of rickets, different authorities advocating 
varying and diverse beliefs. Some have' main¬ 
tained that confinement and lack of exercise are 
causative; while these may be contributing fac¬ 
tors in so much as they lower the general vitality, 
they are not a primary cause as has been proven 
in experimental tests made on animals. Another 
evidence that this is not a tenable theory is 
that rickets often develops at so early an age 
that exercise is not possible. It is usually dur¬ 
ing the first six months of life that the disease 
makes its appearance, too early for any child 
to have had enough exercise to act as a preven¬ 
tive. At the present time practically all close 
students of this prevalent disease are agreed 
that it is a result of faulty nutrition during 
the early months of life. Some have held that 
a deficiency of lime salts causes the trouble, but 
it cannot be induced by a diet deficient in lime 
salts alone, or cured by large doses of these; 
and it has even developed in cases with a dietary 
excess of these minerals. For example, chil¬ 
dren fed on cow’s milk develop rickets much 
more frequently than those who are breast-fed, 
though cow’s milk contains three times as much 
calcium as human milk. It has been proven 


MOTHER AND CHILD 


53 


that the disease is due, not necessarily to a lack 
of calcium in the food, but to a deficiency of 
some factor, the absence of which prevents the 
proper assimilation of calcium and its deposi¬ 
tion in the tissues and bony structures. 

One seeming contradiction of rickets is in 
the fact that a thin, undernourished child is 
less susceptible to the disease than is the over¬ 
fed one. It is the fat, pale, pudgy infant who 
is most apt to be a prey to this disease. This 
convinces one that the fault is not in the amount 
of food but rather in the kind. It is in the fast 
growing child that this deficiency is most appar¬ 
ent, as it is during the months of most rapid 
growth that the disease first appears. 

In England, animal experiments have been 
conducted in the study of rickets which have led 
the experimenters to conclude that the cause of 
the disease lies in a deficiency of the fat-soluble 
vitamin. In America more recent experiments 
have indicated that the lack of sunlight has an 
important bearing upon the development of 
rickets. Whether the anti-rachitic factor is the 
A vitamin itself, or whether it is an associated 
factor found in foods rich in this vitamin which 
affects the retention and deposition of minerals, 
is still an open question, but not one to concern 
us especially here. 

Experimental Studies. —In the desire of corrob¬ 
orating the results obtained by others, and in 
the hope of establishing some new facts in the 


54 


NUTRITION OF 


study of nutrition, the following individual 
experiments were conducted. 

Test on Puppies. —In our first experiment 
we divided a litter of eight puppies into two 
groups of four each. The diets of the two 
groups were chemically equal and identically 
the same, except that one group had its fat in 
the form of butter, while the other was given 
a well-known and highly advertised white vege¬ 
table fat. Both groups had an abundance of 
food rich in absorbable mineral salts. The 
striking results are shown in the accompanying 
X-ray plates of the forelegs of two. puppies, 
one from each group. 

In Figure 6 we notice that the ends of the 
bones are strong and well defined, while in 
Figure 7 we find they are spongy and enlarged. 
In Figure 6 the joints are firmly and closely 
connected and have only the necessary small 
spaces between, while in Figure 7 the spaces are 
much greater, resulting in a looseness of the 
joint. The latter easily assume an irregular 
position when weight is put upon them, the bones 
pressing closer together at one side of the joint 
than at the other. This is equally true in the 
joints of the toes. In Figure 6, the shaft of the 
bone is thick and opaque, while in Figure 7 it 
appears as a thin semi-transparent line. That 
such joints and bones bend easily into bowed- 
legs or knock-knees is not surprising; neither is 




. 




















% * 



























































■ 

■ 



























































































































































. 



















/ 

















































































































































































Fig. 6. —X-ray of forelegs of a puppy that received butter, a full brother of the one 
(shown in Fig. 7) that received a commercial vegetable fat. It is noticeable that at “e. ” 
(Fig. 7) the head of the bone is semi-transparent showing marked calcium deficiency. The 
outer shell of bone at “ D ” is several times as thick as at “ d ” in Fig. 7. 









Fig. 7. —X-ray of forelegs of puppy receiving a commercial, vegetable fat. Compare 
with Fig. 6 noting especially points marked “e” and “d”. Also note the looseness of the 
joints as compared with the close-knit joints in Fig. 6. 




GHOUP 





















MOTHER AND CHILD 55 

the fact that they break more easily than nor¬ 
mal bones. 

Tests. —Similar results were obtained with 
our rats. Figure 8 represents the skeletons of 
four rats, as revealed by the X-ray. These 
were from the same litter, but were placed 
in different groups. As with the puppies the 
diets of the two groups were identical, except as 
regards the fat, group A having butter and 
group B, lard. The rats of group A have bones 
which are darker in appearance, indicating the 
presence of larger amounts of calcium. This 
is especially noticeable in the paws, and in the 
large bones of the hind legs. 

The conclusions to be drawn from experi¬ 
mental results to date are, that the cause of 
rickets is largely dietetic, and that at least one 
important factor in combating its development 
is an abundance of those foods rich in the fat- 
soluble vitamin. 

Cure.— For many years cod-liver oil has been 
known to be effective in the treatment of rickets, 
and this is now recognized as one of the richest 
sources of the fat-soluble vitamin, which charac¬ 
teristic probably accounts for its efficacy in 
curing the disease. Exercise, massage and 
especially sunlight have beneficial effects. There 
are also special appliances for the correction of 
some of the bone deformities, a discussion of 
which is not in place in this volume. It is a curi- 


56 NUTRITION OF 

ous fact that, as a child grows older, the disease 
tends to rectify itself without special treatment, 
and extremely bad cases of rickets may improve 
as the child advances in years, though the mal¬ 
formations of bone and muscle persist in some 
degree throughout life. Season has a marked 
influence on the development and improvement 
of rickets, the disease attaining more severe 
forms throughout the winter months and sub¬ 
siding materially during the summer. Fresh 
air and sunlight, no doubt, have a part in this 
improvement. It may further be accounted for 
by the fact that both animal and vegetable foods 
contain more of the vitamins during the sum¬ 
mer season. 

Prevention.— Although, as has been indicated 
above, the active disease may be arrested and 
the curved leg-bones straighten out in some 
degree, many effects of early rickets continue 
throughout life and tend to cause various ills 
of heart, brain, and digestive system. The child 
who has suffered from rickets, in infancy is 
often a nervous, irritable, easily excitable type 
when he reaches school age, and though he may 
do well in his school work, it is usually at the 
expense of his physical well-being. It should 
be a mother’s concern to see that her child is 
spared an encounter with this disease monster. 
It is so much more frequent among artificially 
fed infants than among those who are mater¬ 
nally fed that breast feeding is the best means a 


MOTHER AND CHILD 


57 


mother can adopt to prevent the early develop¬ 
ment of rickets in her child. A more complete 
discussion of this phase of the subject is to be 
found in a subsequent chapter. 

After breast feeding, a mother should see 
that her child’s diet contains a goodly amount of 
absorbable minerals and of the antirachitic fac¬ 
tor, which is closely associated with fat- 
soluble A. For all practical purposes we 
may consider it as embodied in the A 
vitamin, which is found in animal fats 
and green vegetables, such as spinach, carrots, 
cauliflower, string beans, beets, and asparagus 
tips. Since the amount of fat that a child can or 
should take is limited, it is necessary that this 
amount should be in proper form, preferably 
the fat of milk. A good proportion of this 
should be in the form of butter for children 
over one year of age. Vegetable fats and oils 
should not be given to young children both 
because they are not effective in preventing 
rickets and because they may overbalance the 
diet in respect to fats, causing indigestion which 
favors the development of disease. In addition, 
skin hygiene is .of great importance. Sunlight 
and fresh air in direct contact with the skin 
greatly increase the effectiveness of a good diet. 

After the age has passed with which active 
rickets is associated, the child has need of the 
anti-rachitic diet for the further formation of 
strong bones and good teeth. Though com- 



58 


NUTRITION OF 


pie ted as far as their crowns are concerned 
long before this, some of the teeth require 
until the eighteenth year to calcify their roots; 
any falling off in the mineral or vitamin con¬ 
tent of the food up to that time may result in 
defective teeth or early decay. Throughout 
infancy, childhood, and adolescence, a mother 
should take precautions to safeguard her chil¬ 
dren against the disfiguring and disease-produc¬ 
ing agency of rachitis. 


CHAPTER V 


DIET DURING PREGNANCY AND 
LACTATION 

Proper nourishment for the developing 
young life is the only means by which physical 
health can be assured to the adult of the species. 
As this development commences with the em¬ 
bryo, so must our consideration of nutrition 
begin here. Since the little unborn life is 
entirely dependent upon the maternal organism 
for sustenance, the question of the mother’s diet 
during this time is one of great importance. 

PREGNANCY 

General Rules. —Many of the popular beliefs 
and theories regarding a pregnant woman’s 
dietary are as amusing as they are erroneous 
and unfounded. There need not be any great 
divergence from the usual varied diet, but only 
a closer attention to the completeness of it. 
Sufficient food should be taken by the mother to 
meet the requirements of her own body and, at 
the same time, to furnish materials for nourish¬ 
ing the developing embryo. If her consumption 
of food falls below this minimum the reserve 
energy of the mother ’s body must make up the 
deficiency, with an inevitable loss of weight in 

59 


60 NUTRITION OF 

the mother and a lack of sturdiness in the 
child. However many pregnant women over¬ 
eat, thus causing a rapid increase in weight and 
a consequent indisposition to exercise. The 
mother’s weight increase should correspond 
only to the growth of the child and the ac¬ 
companying membranes. 

Amount of Food Required.—The gain in weight 
of the fetus during the first weeks of pregnancy 
is scarcely more than one gram per day (one- 
thirtieth of an ounce), while the daily ration of 
the average woman consists approximately of 
500 grams per day. Therefore the additional 
food necessary is hardly appreciable. As the 
weeks pass, a more rapid growth gradually 
occurs, and after the sixth month, the amount of 
food required becomes correspondingly greater 
—about ten grams a day additional. There are, 
however, certain body activities that demand 
an increase in food. Often the pulse rate is 
accelerated and, toward the end of pregnancy, 
the respiration is noticeably more rapid. These 
changes require an additional amount of energy 
which must be supplied by food. The appetite 
is the best gauge as to this caloric need, 
for it is less capricious during the last weeks 
of pregnancy. 

Precautions. —There are a few dietary pre¬ 
cautions to be voiced to the pregnant mother, 
as often she is the victim of a very erratic 
appetite, being inclined to overeat or to indulge 


MOTHER AND CHILD 


61 


in an unbalanced ration. She should avoid irreg¬ 
ular meals and highly seasoned or very rich 
foods, which are likely to cause digestive dis¬ 
turbances. Likewise she should curtail the 
amount of sweets, as these not only cause indi¬ 
gestion, but lead to an undesirable increase in 
weight. Thank heaven! the day of the indolently- 
reclining, novel-reading, and chocolate-consum¬ 
ing, expectant mother is largely past. A third 
and very important precaution is in regard to 
animal protein. Meat or eggs, used in excess, 
overwork the kidneys, causing albumin in the 
urine with attendant dangerous complications. 

Minerals.—The importance of minerals is 
often overlooked. If a diet is lacking in calcium, 
for instance, the reserve store in the body is 
called upon to meet the need. A diet may be 
deficient in iron, as is a milk diet, and a person 
so nourished necessarily becomes pale and 
anemic. Green vegetables are our best source 
of minerals, and contain them in adequate 
amounts in a form easily assimilated. Fresh 
vegetables, therefore, constitute an important 
requirement in a pregnant woman’s dietary. 

Water.—The expectant mother should drink 
freely of water; in fact, about three pints of 
liquid daily are advisable. This insures the 
passing of a goodly amount of urine, which is 
essential to the proper elimination of waste 
from the body. The bowels likewise are kept in 
better condition by a liberal supply of water. 


62 


NUTRITION OF 


Vitamins.—Aside from the various food ele¬ 
ments and their caloric values an expectant 
mother requires the vitamin foods in generous 
amounts. A pregnant woman’s resistance to 
disease is usually somewhat lowered at best; 
she cannot afford to risk any deficiency in diet 
which would tend to further this condition. In 
epidemics of beri-beri, pregnant women are 
especially subject to the disease, usually with 
resultant abortion. We have all noted in our 
recent “flu” epidemics how readily the expect¬ 
ant mother became a victim and how frequently 
she succumbed. It has been shown that lack of 
vitamins may render conception impossible. 
The deficiency, on the other hand, may not be 
so complete as to produce sterility, but exten¬ 
sive enough to prevent the development of a 
healthy child with a reserve force in its system 
to combat disease. Not even in infancy are the 
vitamin requirements as imperative as during 
the prenatal stage. The demands upon the sys¬ 
tem of the pregnant woman, both for her own 
sake and her child’s, are too great to risk a 
deficiency in the vitamin content of her food. 

Various Needs.—Whole-grain cereals are 
necessary to promote proper growth and insure 
resistance to disease. The tendency to scurvy 
in the young infant can be reduced considerably 
if during the prenatal period the mother has 
consumed food adequately supplied with the 
antiscorbutic substance, such as raw fruits and 


MOTHER AND CHILD 


63 


vegetables. Perhaps the most necessary vita¬ 
min to the pregnant woman is fat-soluble A. 
An abundance of butter fat and green vegetables 
in her diet will insure strong bones and healthy 
tissues to her offspring. From the green foods 
also are derived the child’s supply of minerals. 
These are especially necessary during the lat¬ 
ter months of pregnancy, which are the bone- 
and brain-forming period. One-third of the 
weight of a new born infant is acquired during 
the last six weeks of uterine life. Premature 
infants almost invariably develop rickets, 
because they have been denied a part of this 
bone-building period. All of the higher brain 
cells originate before birth, and all the teeth 
a child will ever possess are under construction 
long before he is born. The process of enamel¬ 
ling of the first teeth is largely dependent upon 
materials he receives before birth. When a 
mother realizes that the quality of this work¬ 
manship is entirely dependent upon the condi¬ 
tion of her own blood, she has a strong incentive 
to keep her body in the best of repair during 
tills prenatal period. 

Effect of Season. — Even the season of the 
year has its effect upon the bones of the new 
bom babe, the ideal time for a child’s birth 
being early summer. The mother can then have, 
during the last weeks of pregnancy, an ample 
supply of green vegetables and milk fats, rich 
in vitamins. It has long been a matter of com- 


64 


NUTRITION OF 

mon consent among farmers that spring or sum¬ 
mer pigs and calves grow far more successfully 
than fall or winter ones. Now we know the 
secret lies not only in temperature, but also 
in diet. 

The following case is illustrative of this 
point: The mother had always subsisted upon 
a diet consisting largely of pork and corn meal, 
with green vegetables and fruits in season only. 
Both of her children were born in south-eastern 
Missouri in the month of March. The older one 
began cutting teeth at three months, and when 
seen at four years of age, had erupted the upper, 
central incisors of the permanent set which nor¬ 
mally appear at seven years. These were nor¬ 
mal in form, but were covered with a very thin, 
transparent enamel, while of her temporary 
teeth, six were decayed. The younger child’s 
teeth began erupting at two months, and at one 
year of age she had eight teeth, two of which 
were discolored and badly decayed. With such 
early eruption of teeth we realize how wholly 
dependent the child is upon its mother for build¬ 
ing material. These cases of early decay can 
undeniably be traced to an insufficiency of vita¬ 
mins and minerals in the mother’s diet during 
the latter months of pregnancy. 

Effect of Poverty. —The expectant mother 
should have at least one cupful of green vege¬ 
tables daily, measured after cooking; this means 
leafy vegetables or green beans or peas. In 


MOTHER AND CHILD 


65 


addition she needs plenty of butter fat. While 
there is not generally so great a chance of a 
serious lack of the B and C vitamins in her diet 
due to cost, the A vitamin is much more likely 
to be present in wholly insufficient amounts. 
This is due to the fact that the foods richest in 
this factor, milk, butter, eggs, and fresh, green 
vegetables are almost prohibitive in price for 
the poorer classes in our urban districts. Thus 
many of the children of such families are 
deprived of the fat-soluble factor, and it is not 
surprising that we find rickets so rife among 
the offspring of the poorer and more inade¬ 
quately fed mothers. 

Selection of Diet.—With these facts in mind 
the pregnant woman, should maintain a simple 
diet of meat, milk and eggs in moderate amounts, 
combined with whole-grain cereals, and an abun¬ 
dance of green vegetables and fresh fruits. If 
a woman reasonably satisfies a normal appetite 
from foods selected as indicated above, all 
requirements of her own body and those of her 
offspring will be adequately supplied. 

LACTATION 

The fundamental importance of breast feed¬ 
ing cannot be over-emphasized for it is impos¬ 
sible to supply an adequate substitute for this 
natural form of infant nutrition. Since every 
mother should nurse her child, let us consider 
some of the food requirements that render this 

5 


NUTRITION OF 


66 

possible and make it of greatest benefit to 
the babe. 

Amount. —Again, as during pregnancy, the 
amount of food taken must be sufficient to cover 
the needs of both mother and child. This means 
that a woman must increase her food to furnish 
the average thirty ounces of milk per day for 
her infant, as otherwise her reserve store of 
food and energy are called upon to meet this 
demand. Many a mother loses in weight dur¬ 
ing the laetating period, because her intake of 
food is insufficient for the needs of two. On 
the other hand, a mother may gorge herself 
with food, hoping to increase the quantity of 
her milk, but succeeds only in increasing her 
own weight. This is especially true where she 
consumes large quantities of milk, cocoa, and 
thick soups. In fact, milk does not make milk. 
In this are concerned other factors than diet 
alone, which will be considered in the fol¬ 
lowing chapter. 

Origin of Breast Milk. —Milk is a secretion of 
the mammary gland, evolved from materials 
supplied by the mother’s food or by her tissues. 
Therefore, a normal, balanced diet is necessary 
during lactation to furnish the elements requi¬ 
site for the secretion of milk, and to insure in 
this milk an appropriate supply of the necessary 
food factors. To this must be added at least a 
quart of fluid daily to compensate the mother’s 


MOTHER AND CHILD 


67 


body for the loss of this amount of liquid. This 
may be given as water, tea, broth, or thin soups. 

Kind of Food.— -As to the nature of her food 
it must first of all be digestible. Both for her 
own sake and her child’s, a nursing mother 
cannot afford indigestion. The quantity of 
milk secreted is always affected by illness of 
the mother, though the quality may remain the 
same. In general, she need not fear that any 
food she takes will disagree with the child, 
provided it does not disagree with herself. What 
she craves and desires and is able to digest, she 
should have, unless it is clearly demonstrated 
that the child is susceptible to some certain 
food. Proteins in the mother’s diet sometimes 
react unfavorably upon the child. This is espe¬ 
cially true of egg white. Some stubborn cases 
of eczema in infants that will not yield to other 
treatment, do clear up very quickly when eggs 
are entirely omitted from the mother’s diet. 
In cases of indigestion or skin eruptions in a 
breast-fed infant, it is wise for the mother 
to forego eggs for a time to satisfy herself 
if this is the cause of her child’s trouble. The 
old fallacy that a nursing mother should 
not eat acid fruits has worked many an un¬ 
necessary hardship, and has often decreased the 
supply of milk by affecting her appetite. To a 
woman accustomed to fruits, a diet without 
them is extremely monotonous and unappetiz¬ 
ing; the result is an insufficient intake of food. 


NUTRITION OF 


68 

Fruits are also necessary for the prevention 
of constipation. 

Necessity of Vitamins. Teeth. —Important 
as are the vitamins during the prenatal period, 
the necessity for them continues imperatively 
during lactation. This is the period of the most 
rapid growth of any time of life. A child should 
double his birth weight during the first six 
months, and treble it in a year. Any deficiency 
in the mineral and vitamin content of the 
mother’s milk will result in the impaired devel¬ 
opment of the child such as can never be rectified 
even by an excess of these factors in later years. 
The teeth share prominently in this early 
demand for good building materials. As has 
been stated the temporary teeth are completely 
formed and the work of enamelling them largely 
accomplished at birth; soon after birth the 
enamelling of the permanent teeth is begun. 
This is well advanced during the period of 
lactation. At six months of age the crowns 
of the six-year molars, which are the first per¬ 
manent teeth to erupt, are fairly well formed 
and no food taken after this time can in any 
way benefit that portion of their enamelling 
completed at this early date. Just as the char¬ 
acter of the temporary teeth is determined by 
the materials supplied by the mother’s blood 
before birth, so the soundness of the permanent 
teeth is determined by the food the child obtains 
during the early years of life. The crowns 
of the teeth when once formed and enamelled, 



Fig. 9. —Picture made from the Skull of a Mexican child about seven years of age, showing 
all the deciduous teeth perfect and in place, with the permanent six-year molars behind them. 
Note the wide spaces between, insuring ample room for the large permanent teeth, seen 
imbedded in the jaw bones at the roots of the temporary teeth. 



Fig. 10. —Overlapping, irregular teeth, 
with malocclusion, resulting from mouth 
breathing, a diet of “predigested” soft foods, 
and early loss of deciduous teeth. (A bottle- 
fed child). 
















* f H - 

-1 















I H £> I ' III ■ 












MOTHER AND CHILD 


69 


are finished for all time, and no matter how 
poorly the work has been done, nothing can in 
any way improve their imperfections. When 
a mother realizes how much of this work is 
accomplished during lactation, she cannot fail 
to appreciate how great is her obligation to 
furnish proper materials that the quality of 
this workmanship may be of a high order. Not 
only must she consume suitable food, but she 
must keep her body as well as possible in other 
ways. Poisons in the mother’s blood from 
disease have a detrimental effect on the child’s 
teeth. An adult’s teeth are largely made or 
ruined in infancy. 

Rickets in The Breast-Fed.— Breast milk 
may be abundant in amount and “test high” as 
regards fats and proteins, yet be lacking in 
minerals and vitamins. Not every child that is 
increasing in weight is making a consistent and 
proper bone development. Often it is the over¬ 
fat child who develops rickets most readily. 
While it is true that artificially nourished infants 
show evidences of scurvy and rickets more fre¬ 
quently than do breast-fed ones, yet the latter 
develop these deficiency diseases frequently 
enough to convince us that the human mother’s 
milk may lack bone-forming elements. For an 
adequate supply of the vitamins breast-fed chil¬ 
dren depend upon the mother’s milk which, in 
turn, is dependent upon the mother’s diet. 
Studies of rickets among the negro children of 
New York, who are almost universally affected 


70 


NUTRITION OF 


by this disease, have led certain eminent 
authorities to conclude that its wide prevalence 
is due in part to inadequacies of the mothers’ 
diets. It was found that the average negro fami¬ 
ly lived on root vegetables together with car¬ 
bohydrates and meats. There was a great lack 
of milk and green vegetables, our most potent 
sources of the fat-soluble A. The popular be¬ 
lief that green foods in the mother’s diet are 
harmful to the child is erroneous. They must 
be included if the infant is to be supplied with 
the necessary vitamins and the proper amount 
of minerals to guard against rickets and anemia. 
The reader will recall from Chapter III the 
results of our experiments with nursing mother 
rats, and the effect upon their young of the 
mother’s incomplete diets. 

The Anti-scurvy Factor .—It seems difficult 
for the mother to furnish in her milk a sufficiency 
of the C vitamin to meet the needs of her nurs¬ 
ling for a very great period. Hence it is advis¬ 
able to give orange or cabbage juice to the babe 
direct as early as the third month, weeks before 
any other form of artificial food is administered. 
When necessary, diluted orange juice may be 
safely given at the end of the first month. 

The diet of the nursing mother should be 
ample in amount and consist of simple foods 
with enough variety to be palatable. It should 
include the three vitamins, which are best 
obtained from butter fat, green vegetables, 
whole grain cereals, and fresh fruits. In addi- 


MOTHER AND CHILD 


71 


tion there must be a sufficiency of liquid to sup¬ 
ply the amount secreted by the mammary gland. 
If these primary necessities are observed a 
lactating mother has done her part, dietetically, 
to insure to her child sound health, sturdy phy¬ 
sique, strong bones and teeth, and a long, 
useful life. 


MENUS FOR THE PREGNANT OR NURSING WOMAN 


I. 


Breakfast 
Stewed fruit. 

Whole wheat cereal, milk and 
sugar. 

Poached egg or creamed dried 
beef or codfish. 

Whole wheat bread, toasted. 
Coffee, cocoa, or milk. 


Luncheon 

Waldorf or any fruit salad. 
Cottage cheese. 

Graham bread, butter. 

Fig pudding. 


Dinner 


Spanish rice, scalloped lima beans, or corn. 
Creamed cauliflower. 

Head lettuce salad—cabbage or tomato. 
Rolls Butter Jelly 
Gingerbread, with whipped cream, cottage or 
fig pudding. 


II. 


Breakfast. 

Oatmeal with dates, milk and 
sugar. 

Baking powder biscuits, butter, 
jam. 

Coffee, cocoa, or milk. 


Luncheon. 

Omelet with asparagus tips. 
Creamed potatoes. 

Bread, butter. 

Marguerites, tea. 


Dinner. 


Baked salmon with egg sauce. 

Stuffed potatoes. Spinach. 

Whole wheat bread. Butter. 

Fruit gelatine. 


72 


NUTRITION OF 
III. 


Breakfast. 

Fresh berries. 

Cereal, top milk and sugar. 
Graham muffins, butter 
Marmalade. 

Beverage. 


Luncheon. 

Cream of spinach soup. 
Crackers. 

Peanut butter sandwiches. 
Fruit salad. 


Dinner. 


Roast beef with brown gravy. 

Browned potatoes. Green beans or peas. 

Sliced tomatoes. 

Rye bread. Butter. 

Cup custard. 

The sample menus given above* are meant 
only as a basis from which any number of meals 
may be elaborated. Changes may be made in 
respect to fruits, cereals, soups, meats, and vege¬ 
tables, interchanging and substituting others of 
like character. Care should always be exercised 
in preparing a menu that all the food elements 
as well as the vitamin-rich substances are 
included daily. 


CHAPTER VI 


BREAST FEEDING 

The World War taught us many things 
regarding the physical strength and weakness of 
our people. Our pride in our national health was 
rudely shattered when the draft law revealed 
the astounding fact that one-third of our adult 
males were physically unfit. Probably the 
same tests applied to our females, would give 
similar results. The causes of the imperfec¬ 
tions and ill-health of adult life are now being 
sought at their source—the mistakes of infancy. 
The helpless, innocent, crying babe, once con¬ 
sidered a by-product of obstetrics, has become 
the centre of a sociological and medical move¬ 
ment such as the world has never known. The 
baby is coming into his own, and his first and 
greatest demand is for the food God intended, 
his mother’s milk. 

Effect on Mother. Mental and Moral. —As 
has been shown in the preceding chapter, the 
health of adult life depends in a measure upon 
the diet of the mother during the months of 
gestation. Granting that she has been conscien¬ 
tious and scientific in this respect, that she has, 
together with other considerations, been careful 
to consume such foods as are necessary to insure 

73 


74 NUTRITION OF 

a strong, robust, disease-resisting body to her 
offspring, does her responsibility cease when 
she has brought this little life into the world? 
No, her responsibility is but begun. While dur¬ 
ing the months of expectancy she cannot but 
choose to nourish in a measure her child’s life, 
after birth she can evade her duty and refuse to 
continue as the source of his sustenance. Yet 
to the mother, nothing but good can result from 
fully completing the cycle of motherhood.. The 
mental and moral effects are hard to explain or 
define, but she is always a better and finer 
woman for having nursed her child. 

Physical. —The physical effect on the mother 
is more readily demonstrable. For nine months 
the organs of the abdomen have furnished sus¬ 
tenance for the developing young life, with an 
attendant increased blood supply to meet the 
demand upon these organs. After delivery, the 
suckling of the child tends to divert this excess 
blood supply to the breasts, causing the pelvic 
organs to shrink to their former size and weight. 
Often, when a mother fails to nurse her child, 
the abdominal organs maintain a permanent 
enlargement, and various misplacements and 
ill health result. On the other hand, many a 
delicate frail young woman has attained robust 
physique and radiant health by the complete 
experience of motherhood. 

Effect on Child.— Even more noticeable and 
more important than the effect on the mother is 


MOTHER AND CHILD 


75 


that upon the nursing babe. Practically all 
authorities now agree that there can be no ade¬ 
quate substitute for mother’s milk. During the 
period from 1840 to 1910, when calories were 
considered the most important consideration of 
nutrition, commercial companies did their best 
to persuade mothers and physicians that certain 
artificial foods were almost more scientific than 
breast milk. The picture of the overfat child, 
nourished by some patent baby food, is still a 
too familiar sight in magazines and in drug store 
windows. These advertisements do not tell us 
that when a contagion, such as measles, pneu¬ 
monia or influenza comes along, these same over¬ 
fat, artificially nourished infants are the first 
to succumb to the disease. Artificial foods are 
dead foods. They contain calories, but they are 
deficient in vitamins and in other factors pres¬ 
ent in breast milk. Even cow’s milk, superior as 
it is to all other forms of artificial food, is far 
inferior to breast milk. There are marked 
chemical and physical differences between them, 
which account for the inferiority of cow’s milk 
in infant feeding. Differences exist in the pro¬ 
tein, sugar, fats, salts, and ferments, both as to 
quantity and character. There is three times 
as much protein in cow’s milk as in human milk, 
and it is of a much tougher nature, far more 
difficult of digestion by the human stomach. In 
addition to the dissimilarities in the chemical 
composition of the two, human milk contains 


76 NUTRITION OF 

“protective” substances against human dis¬ 
eases, which naturally are lacking in cow’s milk. 
These disparities have an important bearing 
upon the metabolism and development of the 
artificially fed child. The babe’s digestive 
apparatus, which has a natural tolerance 
for breast milk, suffers from a greater 
or less intolerance for cow’s milk. The latter 
can never be modified so as to approximate the 
former in composition or digestibility. The 
Metropolitan Life Insurance Company states 
that they have found the death rate among bot¬ 
tle-fed babies, ten times as great as among those 
breast-fed; other estimates place the ratio at six. 
Hence, from the standpoint of life itself, it is, 
at least, six times as safe to be breast-fed as it 
is to be artificially fed. 

Jacobi stated that 85% of the deaths the first 
year of life are in bottle-fed infants. Statis¬ 
tical studies in England tend to prove his state¬ 
ment correct. In Paris a careful compilation 
of deaths per week among bottle and breast¬ 
fed babies was kept for an entire year. As 
shown in Fig. 11, the deaths every week were 
always greater among the bottle-fed. When 
summer diarrhoea or any contagious disease 
comes along, the death rate is many times 
greater among the bottle-fed. In this case dur¬ 
ing the worst week there were only 26 deaths in 
the breast-fed infants compared with 248 deaths 


MOTHER AND CHILD 77 

in those artificially fed, or the death rate was 
10 to 1 in favor of the breast-fed. 

COMPARATIVE DEATH RATES 


260 



■ = DOTTLE FED H “BREAST FED 


Fig. 11. —Chart showing deaths per week during an entire year in 
Paris (A. B. Marfan). 

Sanitation.— When we consider the unsani¬ 
tary way in which cow’s milk is not infrequently 
































78 NUTRITION OF 

handled, the barns from which it comes, the 
Workmen who come in contact with it, the cans 
in which it is transported long distances, the 
time elapsing before its delivery, the difficulty 
of caring for it properly in the home, and finally 
the greater difficulty of cleansing and sterilizing 
the nursing apparatus, we cannot but concede 
the superiority from a sanitary standpoint of 
warm, human milk, direct from the breast to 
the baby’s mouth, untouched by human hands, 
undefiled by bacteria, undiluted and unchanged 
by artificial means. 

Effect on Teeth. —However, there are far 
more subtle causes of disease than bacteria. 
Rickets with its attendant deformities of bow¬ 
legs, knock-knees, decayed teeth, and misshapen 
chest and skull, is frequently traceable to arti¬ 
ficial feeding. Dentists long ago called our 
attention to the manifold defects of artificially 
nourished teeth. As we have shown in the pre¬ 
ceding chapter, the materials for building 
strong teeth and jaws, are found more abun¬ 
dantly in mother’s milk than in any artifi¬ 
cial food. 

A dentist, who had become especially inter¬ 
ested in this phase of the subject, made a study 
of children’s teeth over a period of several 
months. During this time, he treated patients 
between the ages of three and ten to the number 
of seventy-eight. Of these, seventy-four had 
been bottle-fed as infants; only four of the num- 



Fig. 12. —Illustrating two methods of feeding and the death 
dealing effect of artificial foods. (Courtesy, Dr. I. A. Abt.) 













Fig. 13a.—Twins 3 years of age reared in a cultured home. 1 heir environment, care, and feeding 
were similar except that the one with good teeth was breast-fed for 10 months, while the other was 
bottle-fed. 



Fig 13b.—Impressions of teeth of the twins shown above in Fig. 13a. In the breast¬ 
fed one the jaws are nearly 40% broader and the teeth show proper separation for the age. 
Could one ask for any better demonstration of the benefits of breast-feeding upon the develop¬ 
ment of jaws and teeth? 









MOTHER AND CHILD 


79 


ber had been breast-fed and these required com¬ 
paratively little work. His experience has led 
him to conclude that the breast-fed child rarely 
needs any extensive dental service on his tem¬ 
porary teeth. Another dentist who specializes 
in straightening children’s teeth, reports that 
practically every child coming under his care, 
has been bottle-fed. The few exceptions to the 
rule are children who have been permitted to 
suck the thumb, or who have been allowed to 
eat exclusively of soft foods. 

Another direct and visible effect is the one 
that results from the mechanical process of 
suckling. The act of drawing the milk from 
the mother’s breast, requires sufficient muscu¬ 
lar effort to bring a goodly supply of blood to 
the mouth, nose, and throat. This strengthens 
the muscles of the cheeks and lips, broadens and 
develops the tongue, opens up the nasal pas¬ 
sages, and produces a well formed arch for the 
roof of the mouth. Feeding from a bottle 
requires little effort on the part of the child, as 
the milk usually runs into his mouth from a 
large opening and he merely swallows as he 
would in drinking. The jaws are not strength¬ 
ened and widened and the tongue remains nar¬ 
row and poorly developed, with a consequent 
narrow, high-arched palate. The outcome 
is usually adenoids and enlarged tonsils 
followed by over-lapping, irregular, protruding 
teeth. To insure a proper development of the 


80 NUTRITION OF 

mouth and nasal passages, an infant should 
“work for his living,” not merely swallow 
his food. 

Effect on Muscles. —The effect on the mus¬ 
cular tissue is greatest with the smooth muscle 
fibres, noticeable first in the abdomen. Practi¬ 
cally all artificially nourished children have 
large protruding abdomens. The muscular lay¬ 
ers of the arteries and veins are also affected, 
especially those in the vascular system of the 
lungs. These facts explain the frequent occur¬ 
rence of lung and intestinal diseases among 
persons improperly fed in infancy. A certain 
victim of lifelong dyspepsia says he would 
give half a million for good digestion. 
An investigation of his case revealed the 
fact that he was. breast-fed only three weeks. 
Had his mother foreseen her son's future 
suffering, she would surely have put forth 
every endeavor to give him nature's intended 
food. He cannot go back and start life over, 
but he is helping to save others from sim¬ 
ilar misfortune by furnishing funds for nutri¬ 
tional research. 

Mental Effect. —How much the brain and 
nerves are affected must be judged by fretful¬ 
ness in the babe, nervousness in the older child, 
and nervous and mental diseases in the adult. 
An eminent English specialist in mental dis¬ 
eases, studied into the causes of insanity. He 
found it so frequent among persons who had 


MOTHER AND CHILD 


81 


been bottle-fed in infancy, that he gave np his 
specialty and has since devoted his life to a cam¬ 
paign for breast feeding. His conclusions were, 
“Breast feeding will prevent more insanity than 
can be cured by all the insane asylums of 
the world. ’ ’ 

Capability of Breast Feeding. Who Can Nurse 
Her Child? —It is a curious fact that many per¬ 
sons, and we occasionally find a physician among 
the guilty number, believe that with our highly 
civilized, modern, city life, many mothers are 
incapable of nourishing their infants for more 
than a few weeks. It is perhaps true that it 
is not so easily accomplished as with our grand¬ 
mothers, who lived a more simple and natural 
existence. It is, however, just as possible if 
we meet modern conditions with modern meth¬ 
ods. As Milton says “Accuse not Nature; she 
hath done her part. Do thou but thine.” So 
long as nature renders a woman capable of 
conceiving and giving birth to a young life, she 
is not going to fail to furnish support for that 
life after birth. It may be laid down as an 
axiom that every mother can nurse her child. 
The modern woman, with proper observance as 
to rest, exercise, and diet, and with a determina¬ 
tion to succeed, can accomplish marvellous 
results along this line. The only instances in 
which a mother should not try to nurse her 
offspring, both for her own and the child’s 
sake, are in cases of cancer, active tuberculosis, 

6 


82 


NUTRITION OF 


or insanity in the mother. In the last two 
instances the child should he taken from the 
mother entirely. 

Effect of Menstruation. —The recom¬ 
mencement of menstruation is not an indication 
for weaning as so many mothers suppose. The 
quantity of milk very frequently is less during 
this period, and this is usually the cause of any 
peevishness the child may exhibit. Sometimes, 
however, the milk undergoes a chemical change 
and acquires a bitter taste, so that the child 
either vomits the food or refuses to nurse. A 
mother should accustom herself to the taste of 
her own milk, and if she finds it distasteful 
during menstruation, and it seems to disagree 
with the child, she may resort to artificial feed¬ 
ing for a few days. She must, however, care¬ 
fully express the milk from the breasts at the 
regular nursing hours, so that there may be no 
diminution in the amount when the period is past. 

Pregnancy, per se, is not an indication for 
immediate or premature weaning of a child. 
The common idea that pregnancy renders the 
milk unwholesome is an erroneous one. The 
condition of the mother and nursing infant 
should largely determine when the weaning shall 
take place. Naturally, it is too much of a strain 
upon a woman for her to feed one child at the 
breast and another in utero for a very long 
period, and all three may suffer by the process 
if too long continued. Usually, it is the unborn 


MOTHER AND CHILD 


83 


child who is injured most in such a case. How¬ 
ever, if a woman is in good condition, no great 
harm can result from nursing her child two or 
three months after she again becomes pregnant. 
This gives the mother time to wean the nursing 
infant gradually, avoids many ills, with their 
consequent worry, that come from abruptly 
making this change, and does not necessarily 
affect the unborn child. 

So-called Reasons for Weaning .—Excuses 
for premature weaning of infants from the 
breast are the following: “the milk dried up,” 
“poor quality of milk,” “thin or watery milk,” 
“the breast milk disagreed with the child,” 
“poisonous,” “made the child vomit,” “caused 
green stools,” “caused constipation,” et cetera, 
ad libitum. 

No experiments have been published that 
prove that breast milk is ever poor in quality. 
Milk is often examined to ascertain the percent¬ 
age of fat or other elements. Since the amount 
of fat varies, being small at the beginning of 
the nursing and increasing in proportion toward 
the end of the same nursing, and since it varies 
at different times of day, the only accurate test 
for fat would be that made upon the total amount 
of milk secreted in twenty-four hours. A high 
or a low percentage of fat, accurately ascer¬ 
tained, is no indication that the milk is unsuited 
for the child’s use. A Jersey cow furnishes 
milk high in fat and a Holstein, milk that is low 


84 


NUTRITION OF 


in fat, yet each calf thrives best on its own 
mother’s milk. The blood that feeds the child 
before birth is the best blood to furnish it food 
after birth. In practically all cases where the 
quality of the milk is condemned, the quantity 
alone is at fault. 

Hygiene for the Lactating Mother.—The diet 
for the nursing mother need not differ from that 
of any normally fed, healthy woman except in 
amount and in respect to liquids. A fuller dis¬ 
cussion of this subject is to be found in Chapter 
V. The lactating mother should, of course, 
maintain as perfect health as possible, taking 
daily outdoor exercise, sufficient rest and sleep, 
and avoiding all unnecessary worry. If the 
baby requires much care at night, some member 
of the household other than the mother should 
give the needful attention. When the mother 
of a young babe is forced to lose a goodly share 
of her night’s rest, she cannot be expected to 
secrete an adequate amount of milk the next 
day. Housework, if the heavier tasks are 
avoided, does no harm to the mother, and it is 
better that she have some duties other than the 
care of her child. Exciting and exhausting 
social activities, on the other hand, should be 
avoided entirely during the first weeks of nurs¬ 
ing and, quite generally, until the baby is 
weaned. Any such sacrifice the mother may 
make is more than compensated for by the fu¬ 
ture health of her child, and her own comfort 


MOTHER AND CHILD 


85 


and satisfaction growing out of liis sound health. 
A nursing mother should keep her bowels open 
by the use of fruits and coarse cereals. Cathar¬ 
tics should not be used as they lower her vitality 
and react upon the child. 

Care of the Nipples.— The breasts and nipples 
should be bathed with soap and water at the time 
of the general bath. The mother’s hands should 
be freshly washed before she nurses the babe. 
The nipples should be sponged with a piece of 
gauze dipped in sterile water before and after 
the feeding, or a clean piece of gauze should 
cover the nipples between nursings, to protect 
them from contact with the clothing and to 
absorb any milk that may trickle out. The gauze 
should be thin enough to permit of a free circula¬ 
tion of air. Neither boric acid solution nor 
other antiseptics should be used on the nipples, 
either before or after nursing, as these cause an 
irritation which often results in painful nurs¬ 
ing or in cracked or bleeding nipples. Fre¬ 
quently, when they become sensitive to touch, 
exposure to the air for a two-hour interval twice 
a day is the only remedy required. Bathing 
the nipples with cold water tends to harden them 
and prevent irritation. 

Technique of Nursing.— Maternal love and 
devotion are portrayed both in art and poetry by 
the babe at the mother’s breast. Artists usually 
present the mother holding the child in a natural 


86 NUTRITION OF 

nursing position. In an analysis of the correct 
position, certain facts must be considered. 

Reclining. —The babe first takes the breast 
while the mother is in bed. She should assume a 
comfortable position upon one side. The babe 
should rest on a pillow or folded blanket, his 
head steadied by the mother’s arm, so that his 
mouth is in easy contact with the nipple. The 
child’s nose should be free for breathing, not 
smothered against the mother’s body. If neces¬ 
sary, the mother may hold the breast away from 
the baby’s nostrils with the fingers of her free 
hand. When the milk seems to come with diffi¬ 
culty she may assist by alternately compressing 
and relaxing the fingers upon the breast; if the 
flow is too rapid, she can retard it by maintain¬ 
ing a steady pressure. 

Sitting. —A low chair is best for the mother’s 
use, as less effort is required to elevate the infant 
to the proper height, and the mother’s lap fur¬ 
nishes a more comfortable seat for him. Some 
mothers prefer an arm chair, that they may have 
more support in maintaining the child’s posi¬ 
tion. The babe should be supported by the 
mother’s arm, so that he may grasp the nipple 
easily and naturally. Many babies swallow air 
when nursing, and this distends the stomach and 
causes discomfort until belched up. If allowed 
to collect until the end of the feeding, a consid¬ 
erable quantity of food may be regurgitated with 
the air bubble. An infant thus troubled should be 


MOTHER AND CHILD 


87 


elevated to the mother’s left shoulder once or 
twice during the nursing period, and gently pat¬ 
ted upon the back, that he may relieve himself 
of this excess of air before the stomach is full. 
By this means, discomfort to the child and loss 
of his food may be avoided. 

Schedule for Nursing .—Only in rare cases 
should there be more than six feedings during 
the twenty-four hours. For the convenience of 
the mother and the welfare of the child, the fol¬ 
lowing schedule for the first month has proven 
of practical value; 6 and 10 A.M., 1, 4, 7, and 11 
P.M. After the first month or six weeks, the 
normal child should have but five feedings daily. 
These should be given at four hour intervals 
beginning at six in the morning and continuing 
throughout the day until 10 at night or 6-10-2- 
6-10. From 10 P.M. to 6 A.M. the child should 
receive nothing, except possibly a little water. 
This allows the stomach a full eight hour period 
of rest, which is the best means of preventing 
colic and other forms of indigestion. Such a 
schedule affords the mother time and opportu¬ 
nity for rest, exercise, and relaxation all of which 
are very necessary to her well-being. The old- 
time method of very frequent nursings often ren¬ 
dered the feeding of her child an irksome duty 
to a young mother, and this reacted in a psycho¬ 
logical wayupon the effectiveness of the attempt. 

Alternate Nursings .—The child should be 
nursed regularly fifteen minutes on one breast 


gg NUTRITION OF 

and five on the other alternately, so that each 
breast is emptied partially or completely at each 
feeding. Very frequently a child secures his 
food more easily from one breast than from the 
other. Unfortunately, this sometimes results in 
a neglect of the more difficult one. In many 
women there is a slight difference in the size 
or development of the two breasts, but this 
should not be exaggerated by permitting the 
child to nurse from only one. Such a course 
necessarily results in an abnormal disproportion 
in the size of the two glands; likewise, if the func¬ 
tioning breast should develop cracked nipples 
or become abscessed, temporary relief cannot 
be obtained through using the other breast. Pig. 
14 illustrates a normal difference in size and 
development of the two breasts; Fig. 15 shows 
how this normal variation may give place to an 
abnormality amounting almost to a deformity 
when only one is nursed. In this case, the child 
at two months, refused the right breast. The 
mother humored his whim and continued to give 
him only the left breast. The accompanying 
photograph shows the results when the babe was 
seven months old. For these reasons the 
breasts should share equally in the demand made 
upon them. To maintain a proper flow of milk, 
it is necessary that each breast be emptied four 
times a day. Occasionally a nipple yields milk 
so readily that the child secures an adequate 
amount in less than twenty minutes. Whatever 


MOTHER AND CHILD 


89 


the length of the nursing period, three-fourths 
of the time should be spent on one breast and 
one-fourth on the other alternately. If the 
child shows every indication of being satisfied 
after a fifteen-minute feeding, and is gaining 
normally, he should not be forced to nurse 
longer. However, a mother should assure her¬ 
self that he is getting an adequate amount, and 
is not merely falling asleep from exhaustion. 

Value of Weighing.— The only true means of 
determining the exact state of affairs is by care¬ 
ful weighing. A normal infant should gain 
from four to six ounces weekly during the first 
six months. A larger gain than this indicates 
overfeeding, while a persistent failure to gain 
an average of five ounces per week is sufficient 
proof that the child is undernourished. Mi¬ 
nutely accurate scales of the balance type 
should be used, as the ordinary spring scales 
are not reliable. Proper scales indicate a very 
slight variation in weight and also furnish the 
only means of determining the quantity of food 
the child obtains from the breast. This infor¬ 
mation is gained by weighing the child before 
and after nursing, during a period of twenty- 
f our hours. There should be no change of cloth¬ 
ing between the two weighings of one nursing 
period. Up to three months of age, the child 
should take daily enough breast milk to equal 
one-seventh of the body weight for a normal in¬ 
fant of that age. That is, if he weighs eight 


90 NUTRITION OF 

pounds he should receive daily eighteen ounces 
of breast milk. From the third to the sixth month 
his daily ration should equal one-eighth his body 
weight; from the sixth to the ninth month, one 
ninth his body weight is sufficient. The impor¬ 
tance of weekly weighings of a young infant 
cannot be over emphasized, and if the gain is 
doubtful, daily weighings should be resorted to 
for a time. 


AVERAGE WEIGHTS 


Age 

Boys 

Girls 


Birth 

Pounds 

7% 

Pounds 

7% 


Months 

1 

9 

8% 


2 

ioy 2 

10% 


3 

12 

11% 


4 

13% 

13 


5 

14% 

14% 


6 

16 

15% 


8 

18 

17% 


10 

20 

19% 


12 

21% 

21 


15 

23y 2 

22 


18 

24% 

23% 


21 

25% 

24% 


24 

27 

26% 



Errors in Breast Feeding. Overfeeding. —One 
of the most difficult truths to impress upon 
mothers is that a baby may easily be overfed. 
This may arise from two causes, too frequent 
feedings or too large an amount at each feeding. 
The former, however, is the more usual cause 









MOTHER AND CHILD 


91 


of disturbances arising from this source. Our 
grandmothers believed that whenever a child 
cried he was hungry and should be fed. Today 
this same belief among grandparents is one of 
the serious obstacles to a sensible and scientific 
course of procedure in infant feeding. Restless¬ 
ness, peevishness, and chewing of the fists, are 
not necessarily signs of hunger, as is so often 
supposed, but are frequently indications that 
the child is suffering discomfort from too much 
food. After nursing, it requires from three to 
four hours for the stomach to empty itself com¬ 
pletely. If another feeding be given in two hours 
or so, the fresh milk is poured into that which is 
partly digested, with the result that the former 
feeding must remain too long in the stomach or 
the latter one be rushed out before it is thor¬ 
oughly digested. The little stomach has no 
rest, but is constantly working to care for the 
fresh intake of food. No muscle can work con¬ 
tinuously without growing weak and inefficient 
and showing evidences of pain. One of the 
curious facts about colic is that it rarely causes 
trouble during the morning hours, but in the 
afternoon or early evening makes its regular 
and periodic appearance. The reason is evi¬ 
dent; during the night, when the feedings are 
fewer, the little stomach has a chance to empty 
itself and get a little rest. When the frequent 
daytime feedings recommence, the stomach is 
again gorged, the walls are stretched to their 


NUTRITION OF 


92 

limit, digestion is halted, and pain ensues. 
Naturally, the little fellow cries and chews his 
fists. How false is the idea that this can be 
cured by further filling up the already overclog¬ 
ged digestive apparatus! The pain is similar 
to that of hunger, and causes an increased flow 
of saliva, such as is present when the body is 
calling for food. The obvious remedy is to 
lengthen the intervals between feedings. 

Results of Overfeeding. —Serious results arise 
from the habit of overfeeding, such as, indiges¬ 
tion, dyspepsia, “colic,” nervousness, various 
forms of bowel trouble, flat feet, bow legs, and 
a general lowering of resistance to disease. 
Instances of severe eczema develop in children 
from the third to the ninth month, which require 
months to cure, with a tendency to recurrence 
remaining throughout life. Such cases usually 
give a history of a rapid gain in weight during 
the first three months, accompanied by nightly 
orgies of colic. 

Acute Indigestion. —As overfeeding contin¬ 
ues, one o;f the most common results is acute 
indigestion. Fever and diarrhoea may develop 
with a loss of appetite. For a day or so the 
child may refuse the breast altogether. As a 
consequence of this cessation of stimulus, to the 
mammary gland, the amount of milk secreted 
quickly diminishes. When the child recovers 
from his acute trouble, the food supply is insuf¬ 
ficient to meet his needs. In his weakness, he 


MOTHER AND CHILD 


93 


is unable to furnish a strong enough suction to 
reestablish an adequate flow. He secures less 
and less from the breast, and hence grows less 
vigorous in his demands, until the breasts dry up 
altogether. Thus the vicious circle progresses, 
and finally, when the mother realizes that the 
child is getting almost nothing, bottle feeding is 
resorted to. The fact that this condition usually 
reaches its climax about the end of the third 
month, explains why so many mothers seem 
unable to nurse their infants longer than the 
first trimester. 

Underfeeding. —The picture of the really 
underfed child is quite the opposite, and often is 
very deceptive to the uninitiated. If the child 
is fretful and peevish, he is fed; but frequently 
such a child is drowsy and quiet, spending much 
of its time in sleep. Its very quietness reassures 
the parents that it is doing well, until the trouble 
has progressed so far that there is a very notice¬ 
able failure to gain in weight. This may arise 
from an insufficient quantity of milk, from 
weak suction on the part of the child, or from a 
breast that yields milk with difficulty. In the 
last case, the circular muscle that controls the 
flow of milk from the nipple may be very rigid 
and unyielding. Such a breast requires a much 
stronger suction on the part of the babe than 
does an easily functioning nipple. Often the 
child has not the strength to pursue this stren¬ 
uous task, but tires and falls asleep after a 


94 


NUTRITION OF 


time, and the mother, concluding he is satisfied, 
removes him from the breast. During the first 
few weeks of life, a babe may not nurse well, 
because the sucking reflex may be poorly devel¬ 
oped or because of weakness. In such instances 
the babe will nurse a few minutes, sleep, then 
nurse again, continuing this for thirty minutes 
or more. Whenever a child habitually desires 
to nurse more than twenty minutes, the amount 
obtained from the breast is inadequate for nor¬ 
mal growth. Frequent nursings do not avail in 
such a case, but may aggravate it. Some of the 
symptoms may simulate those of overfeeding, 
such as, green and slimy stools, vomiting, and 
stationary weight. 

Correction of Overfeeding and Underfeed¬ 
ing .—If the babe shows signs of being overfed 
on a correct schedule, it indicates that the 
mother’s breasts are secreting more than the 
child needs. The amount may be reduced by 
giving only one breast at a feeding. There are 
twq reasons for this—first, it is during the first 
five minutes of nursing that the flow of milk is 
more active, so that, with five minutes on each 
breast, the child receives far more than he does 
in a longer time on only one breast; and second, 
emptying each breast less frequently reduces 
the amount secreted. If the child still gains 
too rapidly, an ounce of water may be given, just 
before the nursing, which will lessen the amount 
of milk the child will take. Not so simple a 


MOTHER AND CHILD 


95 


matter is the correction of underfeeding. One 
may resort to complemental feeding: that is, 
supply the deficiency in the amount of breast 
milk with an artificial milk mixture. This, how¬ 
ever, should rarely be done, except as a tempo¬ 
rary measure. A poor, underfed, emaciated lit¬ 
tle creature has his chances of living decidedly 
lessened if he is put upon artificial feeding. If 
the quantity of breast milk is insufficient, the 
imperative need is to develop or increase the 
flow. A strong infant can do this for himself. 
With a weak infant it must be accomplished by 
artificial means. When a temporary illness of 
the child, or of the mother, or some other cause 
has led to an arrest of milk secretion then the 
flow should be reestablished. This is altogether 
possible and practicable, and the method is con¬ 
sidered in detail in the following chapter. 


CHAPTER VII 

DEVELOPMENT OF BREAST MILK 

The mother with a healthy infant, who takes 
the breast readily and who works diligently to 
obtain his food, usually has little trouble in sup¬ 
plying an adequate amount of breast milk. If, 
on the other hand, the child is weak, takes the 
breast reluctantly, or the milk is tardy in mak¬ 
ing its appearance in the breast, artificial means 
must be employed to bring about the desired 
results. Various methods of increasing breast- 
milk have been used, four of which will be con¬ 
sidered here. 

Drugs, —Practically every drug known to 
man, various proprietary and patent medicines, 
as well as malt and spiritous liquors, have all 
been employed for the purpose of breast devel¬ 
opment. Each in turn has proven of no value. 
Some drugs may increase the amount of milk 
in a given time, by acting upon the minute mus¬ 
cle fibres in the breast and thereby hastening the 
flow, but the total amount secreted in twenty- 
four hours remains unchanged. A mother, how¬ 
ever, may require a tonic which, by improving 
her general health, indirectly increases her 
ability to manufacture milk. 

Massage. —The effect of massage, manual or 

96 


MOTHER AND CHILD 


97 


electrical, is more or less beneficial. This with 
hot and cold applications, followed by suction 
with the breast pump undoubtedly results in 
an increased amount of milk. The method, how¬ 
ever, is tedious, expensive, and requires trained 
workers to carry it out successfully, and then 
usually attains less definite results than one 
could wish. 

Diet.—The influence of diet on breast milk 
has long been a mooted question. A lactating 
mother should have additional food and liquids 
to compensate for the daily loss of each through 
the milk secreted. Carefully controlled experi¬ 
ments have shown that if the mother has a glass 
of milk, one egg, or its equivalent in meat each 
day, the protein content of her breast milk will 
be normal. Even if her diet is wholly inade¬ 
quate for two, it does not necessarily result in 
a diminution of the milk supply, for one of the 
laws of nature is that a mother shall furnish 
food for her offspring even at the expense of 
her own nutrition. Except among the very 
poor, a mother’s diet is usually adequate from 
the standpoint of calories. The vitamin con¬ 
tent of her food has no effect on the quantity 
of her milk but only upon its efficacy. Probably 
the most common mistake in practice is to over¬ 
feed a nursing mother, especially upon a milk 
diet. The idea prevails extensively among the 
laity that cow’s milk poured into the stomach 

7 


98 


NUTRITION OF 



Fig. IS. —Illustrates the movements needed to force milk out of the 
little pockets “P” in which it collects. Place a finger and a thumb on oppo¬ 
site side of the nipple at “D” and “D”. Press deeply into the breast in the 
direction of the black arrows. Then compress the breast together in direction of 
the dotted line toward point “ P ”. This will force the milk out of the ducts in 
streams. “ Deep ” and “together ” express in two words the motions required. 













MOTHER AND CHILD 


99 


appears again in the mammary gland. Instead 
it usually fattens the mother, often disagrees 
with her, and if the breasts have begun to dry 
up, they continue in that course. Breast-milk 
cannot be increased by forced feeding of 
the mother. 

Manual Expression.— The fourth method of 
increasing breast-milk is expression by hand. 
Soranus, of Ephesus, as early as A.D. 100, recog¬ 
nized that complete emptying of the breasts 
increased their activity. The whole foundation 
for the» theory of manual expression lies in this 
truth. A parallel case exists in the animal 
world. It is a well-known fact among dairymen 
that the only way to maintain a full flow of 
milk for an adequate length of time in their dairy 
cows is to empty the milk ducts completely at 
regular and systematic hours, and that if this 
routine be in any degree interfered with, a re¬ 
duction in the amount of milk is readily notice¬ 
able. Emptying of the human breast is best 
accomplished by means of a robust infant. When, 
for any reason, the child fails to do his duty, 
then we must give him assistance. Why manual 
dexterity in this art has been so long neglected 
is one of the mysteries of medicine. There are 
various text books which make reference to milk¬ 
ing out the breast by hand, but until recently 
there was none very explicit as to the details of 
the process. 


100 nutrition of 

Technic.*—We had used manual expression 
with success in various cases, but when on Eed 
Cross duty in Italy and France during the war, 
we attempted to teach the method to the doctors 
and nurses who couldn’t understand English, 
it was found necessary to make a more care¬ 
ful analysis of the motions constituting the pro¬ 
cess. In consequence, the following formula was 
evolved. First: with the thumb above and fin¬ 
ger below, about one inch from the nipple, press 
deeply and firmly backward into the tissue of 
the breast; the ‘ ‘ deep ’ ’ motion. Second: main¬ 
taining this pressure, with the same fingers com¬ 
press the breast behind the base of the nipple: 
the 1 ‘ together ’ ’ motion shown in Figs. 18 and 19. 
This forces the milk out of the little pockets in 
which it accumulates. The fingers do not move 
forward nor change their position on the skin 
during the process. Only one hand is required 
for expression; the other holds the glass which 
receives the milk. With a little practice this 
motion can be repeated fifty to one-hundred 
times a minute. If manual expression is prop¬ 
erly performed the milk comes in streams, not 
in drops. When one can project the milk streams 

* Our original description of the technic of manual ex¬ 
pression, published in 1919, included three motions. Additional 
experience in teaching, however, has shown that the third 
motion “out” is unnecessary and often misleading. The words 
“deep” and “together” describe more accurately and correctly 
the motions involved. 




Fig. 20.—First position in the expression of breast-milk from a large, pendant breast, show¬ 
ing the thumb and fingers properly placed and pressing backward. 



Fig. 21.—Second position, showing compression of the breast between the thumb and fingers, 
well behind the nipple, and the milk coming in streams. 









Fig. 22.—Second position showing the thumb and finger pressed deeply into the breast, 
at the same time compressing the breast well behind the nipple. This deeper pressure is 
necessary in a round, virginal-shaped breast. 










MOTHER AND CHILD 


101 


a distance of three feet from the nipple he has 
properly mastered the technic. 

The accompanying diagram (Fig. 18) illustrates the ana¬ 
tomical structure of the breast and the reasons for the motions 
outlined above. Fig. 19 shows the proper position of the finger 
and thumb with reference to the nipple; Fig. 21 the resultant 
streams of milk when the “together” motion is correctly exe¬ 
cuted. In Fig. 20 we have a photographic representation of 
the same position of the fingers shown diagrammatically in 
Fig. 18. 

Cake of Expressed Milk.— The hands of the 
mother or nurse, who is to express the milk, 
should be carefully washed in warm water and 
soap. The nails should be well cleaned and 
short enough so, as to cause no abrasion upon the 
breast. No antiseptics should be used upon the 
nipples, but they should be cleansed with soap 
and water at the daily bath. Just before man¬ 
ual expression they should be gently sponged 
with warm, sterile water. The milk is then 
expressed into a glass or large-mouthed nurs¬ 
ing bottle, which has been thoroughly sterilized. 
The sterilizing is accomplished by placing the 
bottle in cold water, which is slowly brought to 
a boil and boiled hard for ten minutes. The 
fingers or nipples should not be allowed to touch 
the inside of bottle, the contents of which should 
be emptied into a larger sterile receptacle often 
enough to prevent the milk overflowing. A nurs¬ 
ing bottle is large enough to hold the 
usual amount expressed from the breast 
at one time without emptying, and the same 


102 


NUTRITION OF 


bottle can be used for feeding at the next 
nursing period. When the breasts are com¬ 
pletely emptied, the bottle of milk should be 
carefully covered and kept on ice until the next 
feeding time. It is then given to the child after 
he has obtained all he can from the breast by 
his own efforts. The milk may be warmed by 
placing the bottle with nipple adjusted into a 
pan of water, which in turn is heated over the 
fire. To test the temperature of the milk let 
a drop fall upon the inside of the wrist. It 
should feel only lukewarm to the skin. 

Conduct of Case.— In treating these cases of 
breast development our procedure is as follows: 
At the nursing period the babe is put to the 
breast and encouraged to take all he can get in 
twenty minutes, spending half on each breast 
The mother or nurse then expresses by hand 
what remains, allowing at least ten minutes for 
each breast. Even though at first the supply 
of milk is exhausted sooner, this amount of 
time should be given to expression as the milk¬ 
ing motion further stimulates the secretory 
function of the breast. The expressed milk is 
kept on ice and is given the infant from the 
bottle following the next nursing. If this is 
insufficient for the child’s needs an additional 
amount is given of an artificial mixture. In 
order that the latter may taste as much like the 
mother’s milk as possible, milk sugar should 
be used for sweetening. Each day, as the 


MOTHER AND CHILD 


103 


breast milk increases, the amount of artificial 
food is proportionately reduced. Usually, after 
a few weeks, the bottle may be discontinued 
entirely. As the child gains in strength, he 
is able to exert more and more suction, so that 
he secures an adequate amount directly from the 
breast. All food, either maternal or artificial, 
given from the bottle, should come through a 
nipple with a very small opening. The babe 
should work as hard to get his food from the bot¬ 
tle as from the mother’s breast. If the former 
comes too easily, the child will grow lazy, and 
not exert himself at the breast. 

Classification of Abnormal Cases.— There are 
several tyes of cases one encounters in this 
work of insuring breast-milk for every baby 
and these may be classified under three gen¬ 
eral heads: 

1. Establishment. 

2. Eeestablishment. 

3. Development in case of: 

a—Spastic nipple muscles, 
b—temporary reduction, 
c—Weak baby. 

Establishment.— The establishment of a flow 
of milk usually is accomplished without difficulty 
if undertaken within two weeks after the birth 
of the child. In some instances, tiny babes are 
with difficulty induced to take the breast, and 
some do, not nurse well for two or three weeks. 
Such a failure on the part of the child, results 


104 


NUTRITION OF 


in a stimulation of the mammary gland insuffi¬ 
cient to establish an adequate secretion. This 
stimulation must then be supplied by other 
means. The babe should be placed to the breast 
at the regular feeding time and the milk should 
be expressed directly into his mouth. The act 
of swallowing reacts on the muscles of the mouth 
so as to develop the suckling reflex. As the 
child grows and gains in strength, he begins to 
draw lustily for his food, and soon there is no 
further need of manual expression. In such 
cases, if the child is given no assistance, the 
mother later reports that the milk ‘ ‘ never came ’ ’ 
or “was very meagre in amount, and what little 
did come affected the child unfavorably. ’ ’ In 
reality, the fault is not in the milk at all, but 
in the failure of the child to take what there is 
and increase this amount by proper suction. 
The breasts must be emptied regularly to stim¬ 
ulate an increased flow. By perseverence, 
even foster mothers have been able to establish 
a secretion of milk more or less adequate to 
nourish the adopted child. In Oriental coun¬ 
tries, grandmothers frequently nurse their 
daughter’s children. With such instances to 
confront us, no normal mother should doubt her 
ability to suckle her babe. 

Reestablishment.— Reestablishment of breast 
milk becomes necessary when for any reason 
the milk has been allowed to dry up pre¬ 
maturely. If the babe has been weaned for six 


MOTHER AND CHILD 


105 


weeks or less, our rule is to put him back on 
the breast and attempt the reestablishment of 
a flow of milk. In exceptional cases, the attempt 
has been made where the child had been weaned 
for a much longer period. Often the breasts 
have shrunken almost to their virginal size; 
only a small drop of milk can be expressed and 
this with considerable difficulty. Such cases 
require the most patient effort, but success 
awaits the persevering mother and physician. 
In view of the life-saving, health-promoting 
value of breast milk, every effort at reestablish¬ 
ment becomes an imperative duty. 

In Milan, Italy, at the opening of our Red 
Cross Refugee Hospital, the only nurse was an 
illiterate Italian woman without hospital train¬ 
ing. Almost immediately, we received two little 
souls who had been born in box cars during the 
“Great Retreat.” Both had been weaned, one 
for eight and the other for eleven weeks. We put 
them back on the breast, and had each mother 
nurse her child every four hours. The nurse 
would then express all remaining milk. Follow¬ 
ing each nursing, the babe received the milk ex¬ 
pressed after the previous feeding, and in addi¬ 
tion a complementary feeding of cow’s milk. 
The amount given from the bottle varied 
inversely as the amount procured from the 
breast, growing less each day as the flow of milk 
increased. As the little ones grew stronger, they 
emptied the breasts more completely, thus stimu- 


106 


NUTRITION OF 


la,ting further production, so that in a few weeks 
both babes were being fed naturally and grow¬ 
ing steadily. 

Development.— This phase of the subject is 
our most common problem, and comprises those 
instances in which a babe on the breast is making 
an unsatisfactory gain. Many mothers need to 
make some effort at development, if they are to 
nourish their infants for the full nine months. 
Whenever a breast-fed child persistently fails 
to gain, it indicates that for some reason he 
is getting an insufficient quantity of food. 

Spastic Nipple Muscles. —The tense, un¬ 
yielding nipple muscle is one cause for the babe’s 
inability to secure an adequate amount from the 
breast. When a physician, accustomed to man¬ 
ual expression, finds that it takes all the strength 
of his fingers to force the milk through the 
nipple, he can appreciate what a heroic effort 
the tiny babe is compelled to make to secure his 
food. This difficulty is encountered even in 
women who have previously borne children. 
Spastic nipples are occasionally found in a 
woman who has had her first child rather late 
in life, and who is “firm knit,” that is, has tense, 
hard, firm muscles. Spastic nipples seldom 
occur in the soft, pendant breast, but more fre¬ 
quently in the firm round, virginal-shaped gland. 
The only remedy for the trouble is manipulation 
and massage to loosen the tenseness of the mus¬ 
cles so that they will more readily release the 


Fig. 23.—Child of six weeks suffering from Fig. 24.—Child shown in Fig. 23 is here seen as 

starvation, due to mother’s spastic nipples. Manual a husky, breast-fed youngster of ten months, 

expression increased the milk and relaxed the tight 
nipple muscle. 












Fig. 25.—Breast-fed child of three months Fig. 26.—Same child shown in Fig. 25 after 

slowly starving from insufficient nourishment due three months of breast development. Weight 

to weakness of suction. Weight at birth five and at six months, thirteen and one-eighth lbs; gain 

one-half lbs. (Home scales). Weight at three in weight seven lbs. 

months, six and one-eighth lbs. 






MOTHER AND CHILD 


107 


milk from the ducts. Manual expression accom¬ 
plishes this end, and at the same time secures the 
needed sustenance for the child. A typical case 
of spastic or hypertrophied nipple muscle is 
herewith presented. The mother came to our 
clinic with a tiny, wizened, emaciated infant six 
weeks of age. She had been nursing him regularly 
and faithfully, but he steadily continued to lose 
in weight, cried a great deal, was severely con¬ 
stipated, and, if permitted, would nurse for an 
hour and a half at a time. Upon examination 
the mother’s breasts were found to be hard, 
round, and full of milk; manual expression pro¬ 
cured only a few minute drops and even that 
required great muscular effort. The difficulty 
was explained to her and she was taught to 
express the milk by hand. At first, her most 
patient effort secured less than a teaspoonful at 
a time; but in a few weeks the milk had increased 
in amount and the muscles had relaxed to such 
an extent that she was able to express the milk 
freely. The babe (Figs. 23 and 24) who had been 
getting only two-thirds of an ounce per feeding 
at the breast, was able a few weeks later to 
secure by his own efforts all that his body 
required. Such spastic nipples never become 
as yielding as those that permit the milk to ooze 
out freely at all times, but the difficulty can be 
overcome to such an extent that the child may 
secure his full allotment of food directly from 
the mother ’s breast. It is better that he should 


108 


NUTRITION OF 


have to draw lustily for his food than to secure 
it with no special effort on his part. 

Temporary Reduction .—A temporary reduc¬ 
tion in the amount of milk may result from an 
acute illness of the mother, from severe fright, 
from intense or sudden grief, or, occasionally, 
from the recommencement of menstruation. The 
earlier in the life of the child this reduction 
occurs, the more serious are the results. The 
amount of milk secreted is proportionately smal¬ 
ler and the child has less reserve strength to 
withstand even a temporary diminution in the 
amount of his food, and, therefore, less power 
to aid in bringing the breast-milk back to a 
normal amount. Assistance must be rendered 
him in order that the temporary reduction may 
not become permanent and a complete loss of 
milk result. Manual expression should be em¬ 
ployed until an adequate flow is reestablished 
and the child is again gaining normally. 

Weakness of Baby .—The most common cause 
for an inadequate quantity of breast-milk is the 
child’s inability to do his part. A weak baby 
cannot exert strong enough suction to develop 
a sufficient secretion of milk. His weakness 
may be due to prematurity, immaturity, acute 
illness, or partial starvation. Many twins at 
birth are subnormal in weight, and this imma¬ 
turity renders them incapable of exerting them¬ 
selves sufficiently to develop milk secretion. A 
severe 4 ‘cold” with obstruction of the nasal pas- 


MOTHER AND CHILD 


109 


sages, so that the babe must stop nursing to 
breathe, may prevent his emptying the breasts 
properly. 

In all these cases of insufficient breast-milk, 
Whatever the cause, manual expression should 
be employed as long as is necessary to 
establish and maintain a proper secretion of 
breast-milk. In the case of a weak baby or 
spastic nipples, a wet-nurse with a robust in¬ 
fant can be employed to good advantage. The 
mothers exchange babies at nursing times. 
This works benefit in two ways: the weaker 
child obtains sufficient nourishment with less 
effort and thus gains strength to draw harder, 
while the stronger suction of the other child 
upon the poorly secreting breast, rapidly stim¬ 
ulates production there. Manual expression 
is simple enough to be mastered by anyone, and 
has been taught successfully to mothers, doctors, 
and nurses in America, England, France, and 
Italy. No case has yet been encountered where 
breast-milk could not be developed with proper 
perseverance, if undertaken within six weeks 
after the weaning of the child. Some author¬ 
ities maintain that breast feeding is contra¬ 
indicated in women who have not been able to 
nurse former children. That this is no criterion 
the following case aptly illustrates. A mother 
came from a distant city with her fifth child, a 
babe of seven weeks. She had never been able to 
furnish breast-milk for any of her children and 


110 


NUTRITION OF 


all had been artificially fed. One had died from 
malnutrition at the age of four weeks. With 
the fifth baby, she had made an unsuccessful 
effort at breast feeding for two weeks, at which 
time artificial feeding was resorted to. After 
five weeks on the bottle the child was brought in 
weak and emaciated. The mother was informed 
that the babe must have breast-milk, and that 
the establishment of an adequate flow in her own 
breasts was entirely possible. The mother and 
child were placed in a hospital, and instruction 
was given as to the method of manual expres¬ 
sion. To the mother, the effort was amazingly 
successful; the babe thrived, and after seven 
weeks was entirely breast-fed. A year later a 
letter from the grateful father, contained the 
following: “This last baby is better natured, 
healthier, brighter, and more normal than any 
of the others, all of whom were bottle-fed.” 
Previous failures at breast feeding need not 
discourage any mother from attempting breast 
development. 

Two Cases in Detail.— To demonstrate more 
fully the value of manual expression in devel¬ 
oping breast milk, two cases are presented in 
detail; one of which illustrates the development, 
the other the reestablishment type. The first 
shows also to what dietetic extremes mothers 
will go in their endeavor to increase the flow 
of breast-milk. 

Development Case.— This mother came with 


MOTHER AND CHILD 


111 


the statement that her milk was drying up, that 
it “caused vomiting,” and that a physician had 
told her that her milk was ‘ 4 poor in quality.” 
She stated that her daily diet consisted of three 
regular meals, with the addition of fifteen pints 
of milk, six or more cups of tea besides broth, 
soups, and in defiance of prohibition, a bottle 
of beer. Furthermore, she said that she dis¬ 
liked milk, and that it constipated her. The baby, 
a second child, was normal in every way, and 
weighed at birth 6y 2 pounds (hospital scales). 
It had been fed at the breast every three hours, 
and for eight days past had received in addition 
after each nursing, three ounces of an artificial 
milk mixture. It was 21 days old when seen, 
and weighed two ounces less than at birth. The 
mother was assured that her breast-milk was 
doubtless normal in quality, and she was allowed 
to discontinue drinking milk and was directed 
to eat a normal, balanced diet. The baby was 
put to the breast every four hours, being weighed 
before and after nursing. The mother was 
taught the method of manual expression, and 
was instructed to use it after each nursing. By 
weighing the baby before and after nursing, we 
definitely ascertained that it was getting only 
7y 2 ounces from the breast per day. This was 
far below its requirements, both as to liquid and 
calories. That the baby was ill and losing in 
weight was inevitable, while the conclusion of 
those in charge that the milk was disagreeing 


112 


NUTRITION OF 


was a natural one. The child being weakened 
by starvation was unable to nurse a sufficient 
amount for its needs. There remained in the 
breast a residue of 10% ounces of milk. This 
was expressed by hand, and given to the baby 
as complementary feedings. Completely emp¬ 
tying the breasts five times a day rapidly 
increased the milk. Thirty-four days later, the 
amount obtained from the breast by direct suc¬ 
tion had increased from 7% ounces to 20 ounces, 
a gain of 266 per cent. The child had increased 
4% pounds in weight, a gain of 65 per cent. 
The mother began giving a pint of breast milk 
each day to charity and bemoaned the fact that 
she didn’t have twins. The results are tabu¬ 
lated below. 

Development of Breast Milk 

Case No. 681 

Date Age Weight Milk obtained in 24 hours 


' Days Pounds Ounces 

May 17 21 6 4/16 By child .. .- 7 % 

By hand . 10% 

Total 77% 

June 20 55 10 6/16 By child .20 

By hand ... 18 

Total 38 


Reestablishment Case. —This case was the 
second child of healthy parents. As the mother 
was unable to nurse the first child, no better 











MOTHER AND CHILD 113 

results were expected with the second one. After 
two weeks of unsuccessful effort, the baby was 
put on goat’s milk. Though it weighed 6% 
pounds at birth, when seen at five weeks it 
weighed only 6y 2 pounds. The child was still 
losing in weight, was vomiting frequently, and 
cried day and night. Following an explanation 
of the necessity of maternal feeding, the mother 
was assured that, if she did her part, the flow 
of milk could be reestablished, even though the 
baby had been weaned for three weeks. 

Method .—The goat’s milk was discontinued, 
and the following formula substituted: 

Whole cow’s milk. 6 ounces 

(Boiled 1 min.) 

Cereal Water. 12 " 

Milk Sugar. 1 " 

The child was placed to each breast for ten min¬ 
utes, six times daily, and was then given from 
the bottle 3 ounces of the formula. Manual 
expression was employed after each nursing. 
At first the baby secured no appreciable amount 
from the breast, while expression gave only a 
few drops. At the end of the second week, the 
amount obtained by direct suction and by hand 
amounted to 614 ounces daily. As the breast- 
milk increased, the complementary feedings 
were proportionately diminished. In three 
months time, the secretion from the breast had 
increased from a few drops to practically a 
8 





114 


NUTRITION OF 


quart daily, an amount sufficient to nourish ade¬ 
quately a child of that age. Watching the devel¬ 
opment of this child during nearly three years 
has been a distinct pleasure. The difference in 
the physical condition of the two children of this 
household is beyond comparison. Contrasted 
with the perfect teeth, strong chest, straight 
limbs, smooth skin, and glossy hair of the 
breast-fed child are the discolored, decayed and 
broken teeth, the thin bow-legs, pointed and 
grooved chest, pale skin, and harsh, stiff hair 
of her older brother who was denied his birth¬ 
right. The tabulated results of this case are 
given below. 

Reestablishment of Breast Milk 
Case No. 637 


Breast Milk 

Date Age Weight in 24 hours 

Weeks Pounds Ounces 

Jan. 27 . 5 6 7/16 0 

Feb. 12 . 7 6 6/16 

Feb. 20 . 8 6 8/16 9 % 

Mar. 1 . 9 7 3/16 15y 2 

Mar. 11 . 11 7 13/16 20y 4 

Mar. 25 . 13 8 12/16 21% 

Apr. 8 . 15 9 7/16 27 

Apr. 30 . 18 10 11/16 30% 


There is a vast amount of missionary work 
to be done in spreading the gospel of breast 
feeding. The benefits of maternal feeding are 












MOTHER AND CHILD 115 

being promulgated in many places by various 
organizations and individuals. Results are 
everywhere apparent. Whereas a few years 
ago artificial feeding seemed about to displace 
breast feeding, now the latter has become so 
general that few infants are entirely deprived 
of maternal sustenance. This is one of the rea¬ 
sons why the infant death rate has been lowered 
so materially in nearly all parts of the country. 
The ultimate effects will be more apparent in 
the next generation, for breast feeding not only 
saves lives but insures a stronger, sturdier race. 


CHAPTER VIII 


CARE AND FEEDING OF THE 
PREMATURE INFANT 

The life of a premature infant is as depen¬ 
dent upon its care as upon its food. It is, 
therefore, hardly feasible to consider a diet for 
these handicapped little beings, without giving 
some consideration to their general care. 

Premature. —The term ‘ ‘ premature,’’ cor¬ 
rectly used, applies to an infant who quits the 
uterus before the end of nine months gestation. 
The cause may be chronic or acute illness of 
mother, fright, accident, overwork, twins, etc. 
If the birth occurs before the sixth month, there 
is no possibility of saving the child’s life, and 
this is rarely possible in one born before the 
seventh month of gestation. Many seven-month 
infants live if they have proper care from the 
very first. There is no other babe that needs 
the constant, persistent, painstaking, and scien¬ 
tific care that a premature requires. Many 
cases that succumb do so because this exacting 
care and attention have been denied. Some 
authorities claim that a child must have com¬ 
pleted the seventh month of uterine life, and 
must weigh at least three and a half pounds, 
in order to be strong enough to endure extra- 

116 


MOTHER AND CHILD 


117 


uterine existence. However, there are some 
cases on record of babes who have been born 
at six or six and one-half months, and weigh¬ 
ing not more than two and one-half pounds, who 
have made a successful fight for life. It is 
always worth while to try to save any babe who 
makes its exit from the mother’s womb alive. 

Immature.— By the term “immature,” is 
meant a child who has not a normal development 
at birth. This includes, of course, prematures, 
but all immature infants are not necessarily 
premature. Illness on the part of the mother, 
lack of a well-balanced diet, overwork, and simi¬ 
lar causes, may produce an immature infant 
even though born at full term. However, 
whether the child be premature or only imma¬ 
ture, the conduct of the case is largely the same. 
The problems presented are identical: to simu¬ 
late as nearly as possible the intrauterine 
conditions, until the time arrives when the child 
is mature enough to face the world as a nor¬ 
mal infant. 

Characteristics .—There are certain definite 
and pronounced symptoms which characterize 
the premature infant. The thin, undersized, 
oldish looking babe with its claw-like hands and 
weak, wailing cry is a more or less familiar 
picture. The skin either seems stretched across 
the bones or is much wrinkled, as if too large 
for the infant it covers. In either case, there 
is no layer of fat under the skin, which tends to 


118 


NUTRITION OF 


be dry and cold. The premature may feel as 
cold and clammy as a frog. The skin easily 
becomes blue or purplish in appearance with 
a deeper hue about the eyes; the nails of fingers 
and toes may be only partly formed; the skull, 
like all other bones, is unusually soft and the 
fontanelles are wide open. This lack of nails 
and the softness of the bones is accounted for 
by the fact that it is largely during the latter 
weeks of pregnancy that minerals are supplied 
to the babe from the mother’s body. The pre¬ 
mature usually lies in a somnolent condition, 
and this is well, as it has neither strength nor 
development for much activity. 

Care.—The chief object of concern in the care 
of the little premature is its instability of body 
temperature. It is truly a cold-blooded ani¬ 
mal and almost wholly dependent upon outside 
sources for its body heat. This must be estab¬ 
lished immediately after birth, and must be 
maintained at all times. In cases where the tem¬ 
perature is allowed to fall, it sometimes takes 
days to bring it back to normal. Immediately 
after birth, the child should be rubbed with olive 
oil, wrapped in cotton wool, then in blankets and 
placed in an incubator. This latter may be one 
of the patented kinds, but if this is used, the 
top should be removed, as the premature child 
needs fresh air as much as any other. A fail¬ 
ure to realize this fact has caused the suffocation 
of many babes in incubators. A large basket 


MOTHER AND CHILD 


119 


heated with hot water bottles has proven quite as 
satisfactory. The basket should be lined with 
oil cloth or rubber sheeting to prevent drafts 
or escape of heat; upon this in the bottom of 
the basket are placed three hot water bottles, 
which, in turn, are covered with a two-inch pad 
and blankets. The bottles are refilled every two 
or three hours with water at 120° F. (49° C.). By 
means of this contrivance an even temperature 
of 80 to 85° F. (29°C.) inside the clothing can be 
maintained. The rectal temperature should be 
taken at least twice daily and should be main¬ 
tained between 98 and 100° F. (37-38° C.). The 
babe should be handled as little as possible, and 
should not be given water baths. Instead, oil 
rubs are used. For diapers, small pieces of 
cotton-wool should be used. The room should 
be kept at a temperature of about 70° F. (21° C.) 
and should have some arrangement for change 
of air. This method of care is continued until 
about the time the child would have completed 
its nine months of uterine life, or until he is 
thriving well and growing normally. 

Feeding.— Next to the very important sub¬ 
ject of the care for these little weaklings is 
the equally important question of food. All 
that has been said previously as to the urgency 
of maternal feeding for the normal infant, can 
be repeated even more emphatically for the 
premature. The rule may be laid down that 
a premature who does not obtain breast-milk 


120 


NUTRITION OF 


has little chance of living. Since he has been 
denied his full rights before birth, every effort 
should be made to compensate for this in the 
only way possible—by giving him maternal sus¬ 
tenance outside the uterus in the form of breast- 
milk. This is necessary not only to insure life, 
but to overcome the tendency to rickets which 
all prematures exhibit, due to the lack of suffi¬ 
cient calcium in the bones at birth. If the mater¬ 
nal flow of milk is tardy in establishing itself, a 
wet nurse should be employed, or expressed 
breast-milk, obtained from some other source, 
should be given. At the same time, every effort 
should be made by manual expression and, when¬ 
ever possible, by the suction of a sturdy, nor¬ 
mal infant, to establish a flow in the mother’s 
own breasts. Usually a premature is too weak 
and under-developed to nurse normally even 
when there is a goodly secretion of milk. In all 
such instances, the milk should be expressed by 
hand into a sterilized glass or large-mouthed 
bottle and fed to the babe by means of a stomach 
tube or a Breck feeder (Fig. 27), It may be ad¬ 
visable to dilute the breast milk with water for a 
time, as the babe may not handle the whole milk 
well. A premature has a larger food require¬ 
ment than the normal full-term infant in pro¬ 
portion to size, and must not be starved. He 
must not be overfed, however, for this leads to 
indigestion, which no premature can afford to 
face. An amount of food equal to about one- 


MOTHER AND CHILD 


121 


sixth his body weight is a good rule to follow. 
This should be given at regular intervals, not 
less than three hours apart, and 
excellent results have been ob¬ 
tained on the four hour interval, 
with six feedings in the twenty- 
four hours. Water is usually un¬ 
necessary, but if the skin be dry, 
or if vomiting be present, it may 
be administered by mouth or by 
bowel. The premature should be 
weighed weekly on accurate 
scales. At first, his gain need not 
be more than four ounces a week, 
but later, it should be from five to 
seven ounces. As soon as the child 
has attained sufficient size and 
strength, he should be put to the 
breast and taught to nurse. He 
must be kept awake during this 
effort, and may be encouraged to 
“draw” by having the milk ex¬ 
pressed into his mouth directly 
from the mother’s breast. His 
muscles contract with this stimu¬ 
lation, and the act of suckling fig. 27. 
is accomplished. 

Tendency to Infection. —Every precau¬ 
tion should be taken to safeguard the handicap¬ 
ped premature from infections of all sorts, as 





122 


NUTRITION OF 


he is even more susceptible to them than the nor¬ 
mal infant. An ordinary “cold” may be the 
fatal last straw to his already heavy burden of 
maintaining life. A person suffering from any 
form of coryza, common “head cold” or any 
other infectious disease, should be barred from 
contact with the child. This is so important 
that if the mother is thus affected, she should 
wear a mask while nursing or attending the 
child, or whenever she comes within seven feet 
of him. This rule applies admirably also in 
normal cases. 

Later Care .—If the mother, with the aid of 
competent attendants, has been able to bring 
her little premature through the first trying 
three months, and has a healthy, growing, 
breast-fed youngster at the end of that time to 
reward her for her efforts, then she has done 
something worthy of all praise. It is seldom 
that a child born much under term escapes rick¬ 
ets, though with proper breast feeding this may 
be prevented from attaining alarming or dis¬ 
figuring proportions. Because of this tendency, 
solid food should be added to the diet at an 
earlier date than is usually done. Vegetables, 
fruits, and cereals should be given by the fifth 
or six month, with special attention to those 
containing the vitamins and minerals. Slow 
development and a tendency to nervousness are 
evidences of premature birth that often persist 
far into childhood. Hence all the child’s food 


MOTHER AND CHILD 


123 


should be so selected as to correct these unde¬ 
sirable results as far as possible. In some 
cases, it is wise to delay his entrance into school 
until the seventh year, so that any tendency to 
slow mental or physical development may not 
prove a handicap when he meets his fellows in 
the school room. 

Note .—As an illustration of what can be 
accomplished in the case of a premature with 
proper care and breast-feeding, the reader is 
referred to the frontispiece. This child, born 
two months prematurely, weighed only 2% 
pounds at birth. He is here reproduced at the 
age of 6 months. 


CHAPTER IX 


DIET FROM SIX TO 
TWENTY-FOUR MONTHS 

Many children, who experience little or no 
digestive disturbance while on breast-milk, exhi¬ 
bit all sorts of troubles soon after they are 
weaned. Mothers who realize the necessity for 
some sort of routine and for some degree of 
care in feeding a young infant, often discard all 
precautions as to the child’s diet, as soon as the 
first teeth appear. Such children are allowed 
to partake of the same food as the adults of 
the family, without any regard to seasoning, 
digestibility, nutritive value, or vitamin content. 
Many parents complacently boast, that: ‘‘Year- 
old Johnny eats anything the rest of us do.” 
Pickles, rich pies and pastries, puddings, 
sweets, peanuts, salads, ice cream, and quanti¬ 
ties of candy are consumed by very young chil¬ 
dren in many households without a thought on 
the part of the parents. From such injudicious 
and indiscriminate consumption of unsuitable 
foods arise various digestive disorders. These 
may manifest themselves at once as acute dis¬ 
turbances, or may assume a slower and more 
insidious form, such as chronic malnutrition or 
the indigestion of later life. Care equal to 

124 


MOTHER AND CHILD 


125 


that applied to the feeding of nurslings should 
be directed to the gradual change from breast 
feeding to the general diet of older children. 

Before the Sixth Month. —-If a child is properly 
and adequately breast-fed, there is usually but 
one addition to the breast-milk necessary before 
the sixth month. Some form of the C vitamin 
should be given by the third month, for even 
mother’s milk is sometimes deficient in this 
food factor. This is best administered in the 
form of orange or raw cabbage juice, diluted 
with equal parts of water. It is advisable to 
give this about an hour before one of the nurs¬ 
ings, preferably the forenoon feeding. At 
first, only a teaspoonful should be allowed, and 
this is gradually increased until, by the fifth 
month, the child is receiving at least two table- 
spoonfuls daily. The babe, should also be 
encouraged to drink from two to six ounces of 
water daily during these early months; this 
should be boiled and allowed to cool, and may 
be taken at first from a bottle or spoon, and 
later from a cup. 

DIET AT SIX MONTHS 

Schedule 

6 A.M. Breast feeding. 

9 A.M. Orange juice or raw cabbage juice (2 tablespoons). 
10 A.M. Cooked cereal, breast feeding. 

2 P.M. Breast feeding. 

6 P.M. Cooked cereal, breast feeding. 

10 P.M. Breast feeding. 


126 


NUTRITION OF 


During the time the child is wholly breast¬ 
fed, he is dependent for his minerals upon those 
stored up in his body before birth, and upon 
those he receives from his mother’s milk. By 
the sixth month, his reserve is becoming deple¬ 
ted, and the mother’s milk furnishes an inade¬ 
quate supply; this is especially true of iron, as 
a nursing mother is very likely to become more 
or less anaemic. Also, as the supply of breast- 
milk may cease to be sufficient for a rapidly 
growing child, it is best to add some additional 
food by the sixth month. At times this is neces¬ 
sary as early as the fifth month. However, as 
we are here considering the normal, healthy 
infant, and as variations from this need special 
medical attention, we will advise no additional 
food until the sixth month. Cereals, well cooked, 
can be safely given to a child at this age, begin¬ 
ning with two teaspoonfuls and gradually in¬ 
creasing the amount during the month, up to 
two or three tablespoonfuls per day. It is 
advisable to begin with refined cereals. Later 
on, the whole grain preparations will replace 
these. Pearls of Wheat, Wheat Hearts, Far¬ 
ina, or Cream of Wheat may be used at this 
age. These should be cooked for two hours 
in a double boiler. In place of the orange 
juice, tomato or raw cabbage juice may be used, 
the latter prepared as described on page 34. 

Method of Feeding.—The cereal should be 


MOTHER AND CHILD 


127 


given without milk and with only a sprinkle 
of sugar, if any is used, and should be fed from 
a spoon rather than from a bottle. There are 
two reasons for this: first, he must learn to eat 
from a spoon to facilitate matters when weaning 
time arrives; and second, if the cereal is given 
through the nipple, it must, of necessity, be so 
dilute as to be practically a liquid. When thus 
diluted, it gives the child no chance to learn to 
handle solid food, which is a more important 
matter than many persons realize. An early 
effort should be made to teach the child to use 
his jaws, tongue, and later his teeth for masti¬ 
cation, and to discourage the lazy method of 
merely swallowing his food. This exercise 
develops the jaws and teeth, and aids digestion 
by inducing a greater flow of saliva. 

DIET AT SEVEN MONTHS 

Schedule 

6 A.M. Breast feeding. 

9 A.M. Orange juice or raw cabbage juice. 

10 A.M. Cereal, breast feeding. 

2 P.M. Vegetable juice or soup, toast or zwieback, breast 
feeding. 

6 P.M. Cereal, breast feeding. 

10 P.M. Breast feeding. 

Vegetables. —If a child has been gradually 
accustomed to taking cereals from the sixth 
month, there will he little difficulty in adding 
vegetable juices and soups when he reaches the 


128 


NUTRITION OF 


seventh month. This, of course, must be accom¬ 
plished gradually and sometimes is done most 
easily by combining with the cereal. By vege¬ 
table soups, is meant merely the water in which 
vegetables have been cooked, which contains 
many of the elements of the plants themselves. 
If vegetables are cooked in small amounts of 
water, the juices will be quite concentrated. By 
commencing with these, one avoids the distur¬ 
bances that sometimes result if the whole vege¬ 
table is given this early. At the same time 
the child is becoming accustomed to the taste 
he benefits by the minerals contained. Few 
children show a dislike for vegetables, provided 
these have been given during the first year. 
Whereas, if one waits until the second or third 
year as was formerly done, it is almost impos¬ 
sible to inculcate a liking for certain vegetables, 
which usually happen to be the ones most bene¬ 
ficial. Spinach and carrots are the two which 
meet with the greatest disapprobation in older 
children, who have failed to acquire a taste for 
them in infancy, while babes of eight or nine 
months consume them with a relish. 

Cereals. —Wheat Hearts, Cream of Wheat, 
Farina, or Oatmeal may be used and with these 
should be combined an equal amount of whole¬ 
wheat (graham) flour, that the child may have 
the benefit of the germ and the minerals of the 
whole grain. By the end of the seventh month 


MOTHER AND CHILD 


127 


given without milk and with only a sprinkle 
of sugar, if any is used, and should be fed from 
a spoon rather than from a bottle. There are 
two reasons for this: first, he must learn to eat 
from a spoon to facilitate matters when weaning 
time arrives; and second, if the cereal is given 
through the nipple, it must, of necessity, be so 
dilute as to be practically a liquid. When thus 
diluted, it gives the child no chance to learn to 
handle solid food, which is a more important 
matter than many persons realize. An early 
effort should be made to teach the child to use 
his jaws, tongue, and later his teeth for masti¬ 
cation, and to discourage the lazy method of 
merely swallowing his food. This exercise 
develops the jaws and teeth, and aids digestion 
by inducing a greater flow of saliva. 

DIET AT SEVEN MONTHS 

Schedule 

6 A.M. Breast feeding. 

9 A.M. Orange juice or raw cabbage juice. 

10 A.M. Cereal, breast feeding. 

2 P.M. Vegetable juice or soup, toast or zwieback, breast 
feeding. 

6 P.M. Cereal, breast feeding. 

10 P.M. Breast feeding. 

Vegetables. —If a child has been gradually 
accustomed to taking cereals from the sixth 
month, there will be little difficulty in adding 
vegetable juices and soups when he reaches the 


130 


NUTRITION OF 


very hungry, he ate it all, and since that day 
refuses any bread except crusts, and these he 
prefers without butter. He learned how good 
these long-rejected crusts really were, and his 
mother accomplished more than she dreamed 
by her punishment. 

DIET AT EIGHT MONTHS 

Schedule 

6 A.M. Breast feeding. 

10 A.M. Orange juice or raw cabbage juice, cereal, toast or 
zwieback, breast feeding. 

2 P.M. Vegetables (one tablespoon), toast, broth, breast 
feeding. 

6 P.M. Cereal, toast, breast feeding. 

10 P.M. Breast feeding. 

At this age, the orange or raw cabbage 
juice may be given at the beginning of the 10 
A.M. feeding rather than an hour earlier. A 
teaspoonful of butter daily should now be used 
on his toast or on his vegetables. During the 
month there are two important changes in the 
diet. The amount of solid food is gradually in¬ 
creased, and one feeding at the breast is discon¬ 
tinued. Although the schedule at the beginning 
is as indicated above, by the middle of the 
month the process of weaning is begun. The 
10 P.M. feeding is usually the most easily dis¬ 
continued. At eight months, a child is old 
enough to sleep from 7 P.M. to 6 A.M. without 


MOTHER AND CHILD 


131 


any night feeding. When the 10 P.M. feed¬ 
ing is omitted he should receive a somewhat 
larger serving of cereal at 6 P.M. This, fol¬ 
lowed by the breast, usually satisfies him fully 
until morning. 

Broth.— During this month, broth made 
from chicken, beef or mutton, may be given. 
This should be cooled, all fat removed, and 
the broth should then be reheated before being 
fed to the child. 

Vegetables. —Whole vegetables in the form 
of puree are now added to the diet. These should 
be prepared as follows: Vegetables should be 
cooked only until tender. (See page 36.) Spin¬ 
ach for example requires but ten to twenty 
minutes. Use as little water as possible, 
so that none need be drained off. Some 
of the most important properties of vege¬ 
tables can be poured down the drain pipe 
of the kitchen sink. As soon as the plant 
is tender, it should be seasoned with salt 
and butter, or a little meat stock from which 
all traces of fat have been removed. As vege¬ 
tables have too much fibrous tissue to be easily 
digested without thorough mastication, the 
vegetable portion of an infant’s diet should be 
finely divided for him. This is best accom¬ 
plished by rubbing through a sieve, and all 
vegetables should be so treated until the child 
is at least two years old. Spinach, carrots and 


132 NUTRITION OF 

cauliflower may be safely given during the 

eighth month. 

MET DUEING THE NINTH MONTH 

Schedule 

6 A.M. Breast feeding. 

10 A.M. Orange juice, cereal, 2 ounces milk (boiled one 
minute), toast, butter, breast feeding. 

2 P.M. Broth, fresh vegetables (2 tablespoons), baked po¬ 
tato, butter, fruit, zwieback or cracker. 

6-6:30 P.M. Cereal, 2 ounces milk (boiled one minute), breast 
feeding. 

Weaning. —At the beginning of the month, 
the 2 P.M. breast feeding is discontinued. Two 
ounces of milk with the cereal is given twice 
daily; which to the ideally fed youngster consti¬ 
tutes his first contact with cow’s milk. By allow¬ 
ing the child to nurse at the close of the evening 
meal, he has the breast to go to sleep on, and, 
if he is fully satisfied, will sleep soundly 
throughout the night. At nine and a half 
months, another nursing is discontinued, and 
two weeks later the fourth one is omitted. 
Many children will voluntarily wean them¬ 
selves at about this age, but in any case the 
process is not difficult, if conducted gradually 
and systematically. 

Cekeals. —The whole-grain cereals should 
now be used, and the healthy child of nine 
months experiences no difficulty in digesting 
them. In the list we may include whole wheat 
(graham) flour, rolled oats, cream of barley, 


MOTHER AND CHILD 133 

cream of rye, Pettijohns, wheat granules or 
cracked wheat, Scottish oatmeal or cracked oats. 
These may be soaked overnight and then cooked 
thirty minutes over an asbestos mat; or they 
may be cooked two hours in a double boiler, 
with or without previous soaking. The whole- 
grain cereals require a longer period for cook¬ 
ing than the refined ones. The toast should be 
made from whole-wheat bread. 

Vegetables and Fruits.— To the vegetable 
list may be added kale, kohlrabi, Brussels 
sprouts, and fresh peas. All these should be 
prepared as previously directed, cooked in a 
small amount of water until tender, rubbed 
through a sieve, and seasoned with salt and 
butter. As soon as potato is added to the diet, 
there is a tendency to give it cooked in various 
forms and served with gravy. Only baked 
potato, served with butter, should be given to 
infants. Gravy should never be used with 
young children, as it is greasy, indigestible, and 
of no vitamin value. The fruits may now in¬ 
clude apple sauce, baked apple, and cooked 
prune pulp. 

DIET FROM TEN TO TWELVE MONTHS 

At ten and a half months, depending some¬ 
what on the time of the year and how well the 
baby is taking solid foods the last breast feeding 


134 


NUTRITION OF 


is discontinued, and shortly thereafter the fol¬ 
lowing schedule adopted. 

Schedule 

7 A.M. Orange juice, cereal, milk 8 ounces (boiled one min¬ 
ute), toast and butter. 

12 M. Soup, green vegetables (y 2 cup or 4 ounces), baked 
potato, or toast and butter, cooked fruit. 

3 P.M. Cooked fruit pulp, small piece of toast or cracker. 

6 P.M. Cereal, milk 8 ounces (boiled one minute), toast and 
butter. 

At One Year. —Thus at ten and one-half 
months, the child is completely weaned from the 
breast, and is having but three meals a day 
with a midaftemoon lunch. These hours 
should be as closely adhered to as were the 
times of breast feeding. Eemember that now 
the child needs regular habits, simple foods, and 
long periods of stomach relaxation as much as 
he has ever needed them. If these receive care¬ 
ful attention, he will experience no more diffi¬ 
culty than during the months of nursing. The 
benefit of breast feeding should not be counter¬ 
balanced by a careless later diet. The vege¬ 
tables may now comprise quite an extensive 
list, such as, spinach, carrots, cauliflower, string 
beans, beets, peas, kale, kohlrabi, Brussels 
sprouts, and Swiss chard, all cooked of course, 
and put through a seive. Baked potato is per- 


MOTHER AND CHILD 135 

missible daily; soup may be made from chicken, 
beef or mutton, with the fat removed, and vege¬ 
tables may be cooked in this broth. The fruits 
are as important as ever, both as food factors 
and to keep the bowels in good condition. The 
whole-grain cereals also have a function to per¬ 
form in preventing constipation, which some¬ 
times develops when the child begins taking 
cow’s milk. 

DIET FKOM TWELVE TO FIFTEEN MONTHS 

Schedule 

7 A.M. Orange juice, cereal, milk 8 ounces, (boiled one min¬ 
ute) toast and butter. 

12 M. Soup, green vegetables, baked potato, cooked fruit, 
butter. 

3 P.M. Cooked fruit, zwieback, toast or cracker. 

6 P.M. Cereal, milk 8 ounces, (boiled one minute) toast. 

Directions .—To the whole-grain cereals may 
be added rice, white or brown, steel-cut oats 
and coarser cracked wheat. The fruits may 
now include cooked prunes, peaches, pears, figs 
and apricots. The soups and vegetables are the 
same as for the preceding period. A child of 
this age should receive one-half to one cupful 
of fresh succulent vegetable daily, measured 
after cooking. No fried foods should be used. 
Even the bacon is best broiled in a hot oven. 
About a cubic inch of butter may be given daily. 


136 


NUTRITION OF 


A little jelly or jam may be used at this age, if 
spread thinly upon the toast. Fresh cottage 
cheese may occasionally replace the cereal at 
supper; macaroni, rice, or spaghetti may be sub¬ 
stituted for the baked potato at the noon meal. 

DIET FROM FIFTEEN TO EIGHTEEN MONTHS 

Schedule 

7 A.M. Orange juice, cereal, milk 8 ounces, (boiled one 
minute) toast and butter. 

12 M. Meat, green vegetable, baked potato (or macaroni, 
rice, or spaghetti) toast, butter, cooked fruit. 

3 P.M. Toast or cracker with butter. 

6 P.M. Cereal or cottage cheese, milk 8 ounces, (boiled one 
minute) toast and cooked fruit. 

Meat.— There are two methods of prepar¬ 
ing the scraped beef which may be given at 
fifteen months. 

1. A piece of raw beefsteak is scraped with 
a silver spoon, and the particles thus collected 
are formed into a small cake. This is broiled 
in a dry pan over a quick fire. 

2. A piece of rare broiled steak is scraped 
with a thin-edged spoon, and the fine particles 
thus obtained are fed without further cooking 
to the child. A pinch of salt may be added. 

Either of the above methods is equally good. 
The beef may be mixed with the child’s baked 
potato. Begin with a teaspoonful of the beef 
and increase gradually. 


MOTHER AND CHILD 137 

DIET FROM EIGHTEEN TO TWENTY-ONE MONTHS 

Schedule 

7 A.M. Orange juice, cereal, milk 8 ounces (boiled one min¬ 
ute), toast, butter, fruit. 

12 M. Meat, green vegetable, baked potato, or macaroni, 
cooked fruit or simple dessert, made without white 
of egg. 

5:30 P.M. Cereal, 8 ounces milk (boiled one minute), toast, 
butter, cooked fruit. 

Directions .—At this age, the afternoon lunch 
may be discontinued; to accomplish this success¬ 
fully and without difficulty, the child should 
have been taught to eat a substantial dinner 
at the noon-hour. The noon-day dinner should 
be adhered to until the child enters school. 
The morning nap may be omitted, but follow¬ 
ing his midday meal he should have a long sleep. 
When he awakens, he may be given a drink of 
water and taken outside for exercise. This will 
lead him to forget his three o’clock lunch, and 
he will be able to wait comfortably for his 
evening meal, which may be given at 5:30 in 
order to shorten the afternoon interval. At 
this age he may have a tablespoonful or more 
of scraped beef. Simple desserts, such as jello, 
gelatin, corn starch, or arrow-root puddings, 
made with the yolks, but without the whites, of 
eggs, may safely be given. To the vegetable 
may be added asparagus tips, celery, baked 
squash and turnips. Chicken and fish, baked 


138 


NUTRITION OF 


or broiled and finely chopped are also handled 
easily by a child of this age. 

DIET FROM TWENTY-ONE TO TWENTY-FOUR MONTHS 

Schedule 

7 A.M. Fruit juice, cereal, milk 8 ounces (boiled one minute), 
occasionally bacon, toast, butter. 

12 M. Green vegetable, meat or an egg, potato or spaghetti, 
Corn bread, pudding or cooked fruit or custard. 

5:30 P.M. Cereal or whole-wheat toast, 8 ounces milk (boiled 
one minute), fruit or custard and cooky. 

Directions .—At this age we may begin grad¬ 
ually adding eggs, advancing very cautiously 
and watching for any signs of disturbance fol¬ 
lowing their use. In any case, they should not 
be given oftener than three times a week, as 
the whites furnish a concentrated form of 
protein, difficult of digestion for many children. 
Meat and eggs should not be given the same day. 

Toast. —Whole-wheat bread, well toasted in 
a slow oven, should be used. 

Cereals. —Whole-wheat flour, rolled oats, 
cream of barley, cream of rye, Pettijohn’s rol¬ 
led wheat, wheat granules, Scottish oatmeal, 
brown rice, white rice, cracked wheat. Cook 
two hours in a double boiler or thirty minutes 
over an asbestos mat after soaking overnight. 

Vegetables. —Spinach, carrots, string beans, 
beets, peas, cauliflower, kale, kohlrabi, Brus¬ 
sels sprouts, asparagus, celery, Swiss chard, 


MOTHER AND CHILD 


139 


baked squash, turnips, baked potato and maca¬ 
roni furnish a sufficiently large list to admit 
of choice and variety. These should be finely 
chopped, mashed well with a fork, or rubbed 
through a sieve. 

Meat. —Sweetbreads, crisp bacon, scraped 
beef, scraped lamb chop, chicken, fish, liver and 
kidney may be given in moderation, none fried 
except bacon. Liver is one of the most effective 
meat foods because of its richness in the A 
vitamin, and should be quite frequently used in 
the feeding of children. Chicken liver, stewed 
for an hour or less, may be easily mashed 
with a fork and fed without further treatment. 
Two recipes for the preparation of liver are 
here given. 

Preparation of Liver for Cooking .—Wash 
and parboil for 5 minutes. Trim off skin and 
chop finely or put through meat grinder. 

Liver and Rice 

1 cup liver prepared as above 
i/ 3 cup fine bread crumbs 
3 tablespoons tomato juice 
% teaspoon salt 
Mix thoroughly 

Line casserole or baking dish with boiled 
rice and fill the centre with above mixture. 
Place in a pan of hot water, cover, and bake 
25 minutes in moderate oven. Serve hot. 

(See also page 215.) 


140 


NUTRITION OF 

Liver Pate 


(Fowl or calf’s liver may be used). Slice 
and boil twenty minutes in salted water. 
Drain. Mash well or put through food grinder. 
Rub up with liberal quantity of softened butter. 
For older children this may be served in sand¬ 
wiches of whole-wheat bread. 

Desserts .—These may include cooked fruits, 
such as peaches, apples, figs, prunes, pears, 
plums, apricots, tapioca, simple cakes, cookies, 
junket, jello, gelatin, baked custard, and other 
simple desserts containing eggs. 

General Directions .—The child should be 
encouraged to drink plenty of water and should 
be given an abundance of green vegetables, and 
some raw fruit or vegetable each day, as orange 
or cabbage. All bread should be toasted. Pre¬ 
cautions should be taken not to give too much 
milk, or meat, and not to use too much soft 
food. The practice of rubbing the vegetables 
through a sieve may be discontinued, and chop¬ 
ping or mashing thoroughly with a fork may 
be substituted. The child should be taught, 
long before this, to feed himself, and should be 
encouraged to eat his meal in a proper time, 
neither gulping it down unmasticated nor dawd¬ 
ling over it until his appetite is gone. If he 
does the latter, he will not take as much as he 
should, and in a couple of hours will be hungry 


MOTHER AND CHILD 


141 


again. Not more than five minutes should be 
allowed for beginning his meal, and if he is 
not eating well by that time, he should be 
removed from the table and allowed to go with¬ 
out food till his next meal time. Every effort 
should be made to establish correct tastes and 
right habits of eating before the child is two 
years of age. 


CHAPTER X 


ARTIFICIAL FEEDING 

Every child thrives best upon mother’s milk. 
The benefits to the nervous, muscular, and bony 
systems of the body derived from maternal feed¬ 
ing can never be entirely duplicated by the most 
careful, scientifically controlled, artificial feed¬ 
ing. Human milk is intended for the digestion 
of the human infant and its chemical composi¬ 
tion is suited to the special needs of his body. 
This is particularly true during the first weeks 
of life. If a child cannot have breast-milk for a 
longer period, every effort should be made to 
furnish it to him for at least three months. An 
infant who secures this portion of his birth¬ 
right usually acquires a sturdiness of physique, 
a resistance to disease, and a stability of diges¬ 
tion, which render a change to artificial feeding 
less disastrous. 

Some sturdy infants seemingly do well from 
birth on cow’s milk. Growth and weight, how¬ 
ever, are not the only standards of success in 
infant feeding. There are far subtler effects 
upon the muscles, teeth, and nerves which do 
not become apparent until later in life. If to 
these are added the more immediate results of 
acute indigestion, the evil effects are many 

142 


MOTHER AND CHILD 


143 


times multiplied. During the first few weeks 
of life the difficulties arising from artificial feed¬ 
ing are frequently very great. The child has 
little tolerance for any artificial combination 
and his digestion is easily upset. The error is 
then made of thinking that the trouble is due to 
the special kind of food in use, and a change is 
made to some other brand. Frequently a poor 
little emaciated creature of four or five months 
has been the object of experiments with half a 
dozen infant foods, until his digestion is so 
weakened that it becomes a matter of the great¬ 
est difficulty to establish a tolerance for any food. 
It is a lamentable fact that the majority of 
infants who are subjected to bottle feeding are 
the ones least able to thrive upon it. They 
are very often the ones, who for some reason, 
have failed to make satisfactory gain on 
mother’s milk and who already have acquired 
a lowered food tolerance because of digestive 
disturbances. What a mistake to take an 
already ailing child from the breast and subject 
it to the dangers of artificial feeding! Such a 
case frequently has a fatal termination. 

There is usually just one reason for a child’s 
failure to thrive on mother’s milk, and that is 
an inadequacy in amount. This is due to insuf¬ 
ficient suction on the part of the child, with 
resultant insufficient stimulation of the mam¬ 
mary glands. The child may be weak or pre- 


144 


NUTRITION OP 


mature; he may have a poorly developed suck¬ 
ling reflex, or a nasal or bronchial infection may 
interfere with his power of suction. Any of 
these conditions will prevent his taking enough 
from the breast to induce growth, and dyspep¬ 
sia, apparent or real, follows. Such an infant 
is a poor specimen to be put on artificial feeding. 
Instead, the breast-milk should be increased, 
directions for which are given in Chapter VII. 
Every mother can nurse her child and should do 
so with but a few rare exceptions. A mother who 
is suffering from active tuberculosis, cancer, 
or insanity, should not be expected to perform 
this function, and it is better for the child if 
she does not. In cases of the diseases mentioned 
above, or in the instance of death of the 
mother, some other means of feeding the child 
must be devised. The best solution is to secure 
a wet-nurse or obtain expressed breast-milk 
from some mother, who has either lost her own 
child, or who has enough milk for two. If 
breast-milk cannot be obtained for the entire 
sustenance of the child, even a few ounces daily 
are well worth while. This must, of course, 
be supplemented with artificial feedings. Every 
effort should be made to secure breast-milk from 
some source for at least three months, and for 
six to nine months if possible; this is particu¬ 
larly necessary if the child is not thriving well. 
Mothers who must go outside the home to work 
should make every effort to spare three months 
from industry to nurse their offspring. The time 


MOTHER AND CHILD 


145 


is undoubtedly not far distant when govern¬ 
ments will make it unnecessary, economically, 
for a mother to leave her young infant during the 
first months of life. Realizing that there are 
mothers who, for financial reasons cannot nurse 
their children, and that there are certain other 
instances where maternal nursing is inadvis¬ 
able, or where the death of the mother pre¬ 
cludes it, this chapter on artificial feeding has 
been prepared, with the hope that it may never 
be used where there is any possibility of procur¬ 
ing breast-milk. There are so many difficulties 
and even dangers arising from artificial feeding 
that an infant so handicapped should have the 
most careful medical supervision. 

Selection of Food.—When artificial feeding 
must be resorted to, the question of the kind 
of food becomes one of the greatest importance. 
During the past generation there have been 
many and varied patented foods put on the mar¬ 
ket, most of which are highly advertised. These 
usually consist of milks preserved by canning 
or drying, both of which processes tend to des¬ 
troy the vitamins present in natural and fresh 
food. Likewise the ones in most common use 
and which find the highest favor among the 
laity are very high in sugar. Many proprie¬ 
tary infant foods contain over eighty per cent, 
of carbohydrates. The result of using such 
foods, provided no acute digestive trouble devel¬ 
ops, is an excessively fat child, who makes a 

10 


NUTRITION OF 


146 

good showing in an advertisement, but who is 
often wofully deficient in bone, nerve, and mus¬ 
cle development. The long continued use of 
evaporated, condensed, or dried milh often 
results in scurvy and rickets. One mother, who 
had raised two children on a canned food with¬ 
out noticing any difficulty, had come to the 
conclusion that prepared food was superior even 
to breast-milk. She was less successful with 
the third child, however. When eight months 
of age, he developed an acute and aggravated 
form of scurvy. The swellings above the elbow 
and knee are very noticeable in the X-ray pic¬ 
tures which were made during the height of the 
trouble. (See Figs. No. 28 and 29.) 

Condensed Milks should not be used if good 
fresh milk is obtainable; they are useful in times 
of epidemics or on journeys, when it is difficult 
to obtain pure fresh milk. Powdered foods, 
if used at all, should usually take the place of 
sugar in infant feeding. When artificial feed¬ 
ing becomes necessary, the best substitute for 
mother's milk is properly modified cow's milk. 
This is easily obtainable, moderate in price, and 
has most of the elements necessary for normal 
development. 

Care of the Milk.—The utmost care possible 
cannot render cow’s milk as sanitary as breast- 
milk. The best obtainable is none too good. 
The cows should receive some green food in 



Fig. 28. —X-ray of baby, showing swelling 
under the periosteum of the bone at X, due to 
hemorrhage occasioned by scurvy. This was 
caused by an exclusive diet of condensed milk. 



Fig. 29.—Same case as in Fig. 28, showing 
a scurvy swelling above left knee at X. 


























v 







































































































































































MOTHER AND CHILD 


147 


winter as well as summer, as this renders the 
milk richer in the A vitamin than when an exclu¬ 
sive diet of dry food is maintained. The milk 
should come from a reputable, inspected dairy 
and should be pastuerized. It should be deliv¬ 
ered regularly daily and as fresh as possible. 
If the delivery is irregular, a mother is often 
forced to use milk left over from the previous 
day*for one or more feedings. In some cities 
certified milk is obtainable, and is usually the 
safest for infants’ use. This is provided by 
dairies which meet the most stringent require¬ 
ments for healthy cows, cleanly surroundings, 
and sanitary methods of milking. The milking 
is done by scrupulously clean, entirely healthy 
individuals. As soon as drawn, the milk is 
placed in sterilized bottles, rapidly cooled, and 
maintained at a, temperature below 50° F. until 
delivered to the customer. In the home, milk 
should, likewise, be kept on ice or in a cold place 
until ready for use. 

Preparation of Food.—The amount of milk 
necessary for all the feedings of the next twenty- 
four hour period should be boiled over an asbes¬ 
tos mat or in a double boiler. If the former is 
used, the container is placed on a mat directly 
over the fire and, as soon as tiny bubbles appear 
on the milk, the fire is turned off, the pan being 
left on the hot mat for three minutes. In the 
latter method, the milk is put into a double 


NUTRITION OF 


148 

boiler with the water below at boiling point, 
and this is boiled for eight minutes. Which¬ 
ever method is used, the milk should be cooled 
rapidly after removal from the fire by placing 
the container in cold running water. If a scum 
forms on the milk it should be removed. This 
is a calcium compound, of which there is an 
excess in cow’s milk. Boiling destroys bac¬ 
teria, which are always present in the milk even 
with the most careful handling. Many throat 
infections in children have been traced to the 
use of unboiled pasteurized or certified milk. 
Boiled milk is also far more digestible than the 
unboiled. Many infants who show marked 
digestive disturbances on raw milk are able to 
handle the same milk boiled without any diffi¬ 
culty. Raw milk may cause diarrhoea from the 
bacteria contained therein, or may lead to con¬ 
stipation with hard, bean-like curds in the stool, 
or a hard, gray “soap” stool. The casein, 
which is much tougher than in human milk, is 
softened and broken up by heating and hence 
rendered more digestible. The heat is not pro¬ 
longed enough to affect seriously the vitamin 
content of the milk, and any deficiency it may 
exhibit in this respect is more than counterbal¬ 
anced by the advantages from boiling. The C 
vitamin, which is the one most affected, can be 
easily supplied in fresh fruit juices. A table¬ 
spoonful of orange juice contains more Of the 


MOTHER AND CHILD 


149 


C vitamin than a quart of fresh milk. As whole 
undiluted cow’s milk is difficult of digestion for 
most infants, it usually should be modified by 
the addition of water or, better, cereal water. 
The diluents are mixed with the cooled boiled 
milk and put at once into sterilized nursing bot¬ 
tles, one for each feeding of the day. These are 
then kept on ice or in a cool place until required 
for use. The milk may be warmed at the feeding 
time by placing the bottle in a pan of cold 
water and heating over the fire. The temper¬ 
ature of the milk may be tested by letting a 
drop fall on the inside of the wrist. 

Diluents.—The best diluent, for several rea¬ 
sons, is made from whole-wheat flour, unheated 
in the process of milling. Various cereals 
may also be used. Cereal water is made by add¬ 
ing two level tablespoonfuls of the flour or cereal 
and one-eight teaspoonful of salt to a quart 
of water and boiling the whole down to 
one pint. This is then strained through 
a boiled cheese cloth to remove any large 
particles which might clog the hole in the 
nipple. Cereal jelly is similarly made except 
that four tablespoonfuls of the cereal are added 
to a quart of water and the whole reduced to 
a pint by boiling. For thick cereal jelly eight 
tablespoonfuls of the cereal are required. Cane 
sugar, unless it should cause too much fermenta¬ 
tion, is the best sugar to be used; it is pure, has a 


150 


NUTRITION OF 


definite caloric value, is cheap, and always ob¬ 
tainable. The patent baby foods in powdered 
form are largely sugar and in some cases of 
dyspepsia form an admirable temporary addi¬ 
tion to the diet. They help to produce a rapid in¬ 
crease in weight and by their fermentative 
action tend to counterbalance the constipative 
action of the milk casein. They should always be 
considered as temporary foods or as sugar to be 
used in milk modification. 

Technique of Bottle Feeding.—The bottle 
should preferably be a wide-mouthed one with a 
simple nipple, both of which are easily cleaned. 
No glass or rubber tubing or small-necked bottle 
should ever be used. The nipple should have 
a small opening to render a distinct effort on 
the part of the child necessary in obtaining his 
food. The bottle should be held in the hand of 
the attendant, and elevated sufficiently to pre¬ 
vent air being drawn in with the milk. The 
baby’s head should be supported by the nurse’s 
arm or a pillow to facilitate swallowing. Even 
when the child is older, he should not be allowed 
to hold his own bottle. He cannot remove it for 
breathing, and, consequently, drinks too rap¬ 
idly, or loses the nipple, so that the milk oozes 
out about his head and face. As soon as the 
child has finished his feeding, the bottle should 
be removed. If he is allowed to amuse himself 
with the empty bottle, he will acquire the habit 


MOTHER AND CHILD 151 

of using the nipple as a pacifier, from which 
pernicious results follow. 

Care of Nursing Apparatus.—There is no better 
medium for the growth of bacteria than milk. 
Any negligence in the care of the bottles and 
nipples may result in some serious form of stom¬ 
ach and bowel trouble. Milk should never be 
allowed to sour in the bottle when this is at all 
preventable. If such a misfortune does occur, 
as upon a journey, for instance, a brush should 
be employed to remove all traces of the coagu¬ 
lated milk. The proper method is to rinse out the 
bottle thoroughly with cold water immediately 
after its use. Once a day all the bottles should 
be sterilized by placing them in cold water which 
is gradually heated and boiled for ten minutes. 
It is well to do this just before preparing the 
day’s quota of food that the bottles may be 
freshly sterilized when the food is put into them. 
The nipples should not be boiled, as this 
tends to soften the rubber. They should be 
carefully washed, inside and out, with soap and 
hot water and rinsed with boiling water. They 
may then be placed in a dry, sterile, covered 
dish until required for use. No antiseptics or 
strong washing powders need ever be employed 
in cleansing the nursing apparatus. They are 
unnecessary if the sterilizing is correctly done, 
and their use often results in an irritation of 
the tender membranes of the mouth. 


152 


NUTRITION OF 


SCHEDULE FOR ARTIFICIAL FEEDING. 



Amount 




Orange 

Juice 


Toast 

Vege- 

of per Whole Cereal 

Age Feeding Feeding Milk Water 

Sugar 

or table 

Cereal Zwieback Pur6e 

Days 


tsp 

ozs 

ozs 

tsp 





1 

3 

4 

% 

iy 3 

% 





2 

6 

4 

iy 3 

2% 

1 







ozs 



OZS 





3 

6 

1 

2 

4 

y 2 





4-7 

6 

2 % 

5 

10 

i 





7-14 

Weeks 

6 

3% 

8 

12 

i 





2-4 

6 

4 

10 

14 

i 





Months 





tsp 




1 

5 

5 

12 

13 

i 

1 




2 

5 

5 

14 

13 

U/4 

2 




3 

5 

6 

16 

13 

1 % 

3 








Cereal 










Jelly 


This 




4 

5 

6 

18 

12 

iy 2 

1 

This 



6 

5 

ey 2 

20 

12 

i% 

2 

1 

Slice 


6 

5 

ey 2 

22 

10 

iy* 

2 

2 

1 

This 

7 

5 

ey 2 

24 

8 

iy 2 

3 

3 

1 

1 

8 

5 

«% 

24 

8 

iy 2 

4 

6 

1 

2 


The above table is given as a guide for arti¬ 
ficial feeding during the first eight months. 
Begular hours for feeding and a long period of 
rest for the stomach at night are even more 
imperatively necessary than with the breast¬ 
fed child. There should never be more than 
six feedings during the twenty-four hours, 
and these should be reduced to five during 
the second month. Six and 10 A.M., 1-4-7-11 
P.M., are the most universally convenient 









MOTHER AND CHILD 


153 


feeding hours for the first schedule, chang¬ 
ing to 6-10-2-6-10 when the five feedings 
are adopted. The cereal water is used in modi¬ 
fying the milk until the fourth month, at which 
time the cereal jelly is substituted. After the 
first month orange juice should be given daily. 
This is especially important with artificially fed 
babies in order to prevent the development of 
a pale, pudgy, anaemic youngster. Thick cereal, 
beginning with a teaspoonful, should be given at 
five months. This is given with only a sprinkle 
of sugar. The cereal may precede the bottle 
at the 2 P.M. feeding. At the sixth month, 
toast or zwieback is given to strengthen the teeth 
and jaws, w T hich, in a bottle-fed child, are likely 
to be very poorly developed. This may pre¬ 
cede the 10 A.M. bottle. After the bottle, the 
hunger is appeased, and the child is less likely 
to exert himself to munch the toast. At seven 
months, vegetable purees are added. Directions 
for the making of these are to be found on 
page 131. The iron stored up in the body at 
birth becomes inadequate by the seventh month, 
and green vegetables are, therefore, very neces¬ 
sary at this age. The following may be used 
as a daily schedule for an artificially fed child 
of eight months. 

6 A.M. Bottle. 

10 A.M. Orange juice, toast, cereal, bottle. 

2 P.M. Vegetable puree, toast, bottle. 

6 P.M. Cereal, bottle. 

10 P.M. Bottle. 


154 


NUTRITION OF 


At nine months change to:— 

6 A.M. Whole milk 6 ozs., (boiled one minute). 

10 A.M. Orange juice, cereal, (whole grain) toast and butter, 
whole milk 4 ozs. 

2 P.M. Vegetable puree, 2 tbls., toast with butter; cooked 
fruit (prunes, apple sauce) whole milk 4 ozs. 

6 P.M. Cereal, whole milk 5 ozs. 

10 P.M. Whole milk 5 ozs. 

‘ Caloric Values of Foods for Infant Feeding 


Foods 

Amounts 

Calories 

Cane Sugar . 


120 

Carrots, cooked .... 


13 

Cereal, cooked . 

... 6 T 

50 

Cereal water . 


3 

Cereal Jelly . 


6 

Cereal Jelly, thick . 

. .. 1 oz. 

12 

Cream 16 per cent. . 


54 

Custard . 


60 

Flour . 

. .. 1 oz. (4T.) 

100 

Flour, Whole wheat . 

... 1 oz. 

100 

Human Milk. 


21 

Milk, whole . 


21 

Milk, skimmed . 


11 

Milk Sugar . 


130 

Orange Juice . 


12.5 

Rice, boiled. 

.. . 4 T. 

60 

Scraped beef . 


40 

Soup (chicken) .... 


15 

Spinach, cooked. 


8 


Equivalent Measures 

12 T. = 1 oz. liquid 2% T. cane sugar = 1 oz. 

6 t. = 1 oz. liquid 3 T. milk sugar = 1 oz. 

8 oz. = 1 C. liquid 16 T. cooked cereal = 1 C. (8 oz.) 
C = cup T = tablespoon t = teaspoon 






















MOTHER AND CHILD 


155 


Weaning.—The process of weaning a child 
from the bottle should present less difficulties 
than weaning from the breast. There need be 
little or no change in the food, except in the 
manner of giving it. From the sixth month, 
the child should gradually become accustomed 
to drinking from a cup, first water and later 
milk. If the bottle is too long continued, a young¬ 
ster becomes very loath to give it up. We 
sometimes see a child of two years still taking 
his milk from a bottle. At about ten months, 
if he is eating well of cereals, toast, and vege¬ 
tables, as he should be, and has learned to drink 
from a cup, the bottle feedings may be gradually 
discontinued. The 10 P.M. feeding is the first 
to be omitted. When this is done, the six 
o’clock meal is somewhat heavier in milk and 
cereal than formerly. A week or so later the 
2 P.M. bottle is discontinued, and at this time 
the usual amount of milk is given from a cup, 
following a meal of vegetable puree, cereal, and 
toast. A few days later, if all is going well, 
the 10 A.M. feeding may be given without the 
bottle. This meal should commence with orange 
juice, after which cereal, toast, and a cup of 
milk are given. For about two weeks longer, 
the 6 o’clock morning and evening feedings are 
continued. Then the morning bottle is omitted 
and the child has his breakfast at seven, dinner 
at 11:30 A.M., lunch at 3 P.M. and supper at 
5:30 or 6 P.M. The supper may end with the 


156 


NUTRITION OF 


bottle for two weeks or so, or until he is about 
eleven months of age. When the bottle feedings 
are entirely discontinued, the schedule for the 
artificially fed child becomes the same as for 
the breast-fed youngster of the same age. The 
reader is, therefore, referred to Chapter IX 
which contains monthly schedules for the newly 
weaned child. 

General Directions .—Every care should be 
exercised to counteract the evils and dangers 
of artificial feeding by regular habits and well- 
balanced meals. All through infancy and early 
childhood the artificially fed child needs to be 
more carefully dieted than the one who has 
enjoyed maternal feeding. The tendency to 
suddeii and acute digestive upsets continues 
sometimes far into school age. A bottle-fed 
child is much more likely to show later idiosyn¬ 
crasies to cow’s milk than does one who has been 
breast-fed, and often needs to be denied milk 
quite largely later on. The teeth demand more 
careful attention, the nervous system is often 
less stable, and the tendency to infections much 
more pronounced. All these factors render a 
physicians advice imperative, with regular and 
periodic examinations throughout infancy and 
early childhood. 


CHAPTER XI 


DIET FOR THE OLDER CHILD 

Most children at the end of the second year 
have sufficient teeth for proper mastication, and 
are able to handle- a wide variety of food. The 
problem now becomes one of adequacy from 
the standpoint of the various food elements. A 
mother should not, at this time, relinquish the 
the care and vigilance previously exercised in 
planning a well-balanced ration for her children. 
As long as growth continues, the question of 
diet is of the utmost importance. 

PRE-SCHOOL AGE 

General Suggestions.—After the second year, 
the diet of the normal child is more easily stan¬ 
dardized, and need not undergo as frequent 
changes as formerly. The food should still be 
simple and nutritious and be eaten at regular 
hours. The child should continue for two years 
at least taking his meals alone, or with the 
other children of the household only. Rarely do 
we find a family in which the adults eat so 
simple a diet that young children may safely 
partake of the same foods. This is especially 
true of dinner and, particularly, if guests are 
frequently entertained. Play should be natural 

157 


NUTRITION OF 


158 

and permit opportunity for development of indi¬ 
viduality. A child who always plays under 
adult supervision never becomes capable of 
amusing himself, and develops into a fussy, 
peevish, nervous individual. Sleep should be 
abundant and undisturbed. The afternoon nap 
should continue until about school age. 

Meals. Breakfast. —There should be but 
three meals, breakfast, dinner, and supper. In 
certain cases a midafternoon lunch is permissi¬ 
ble. Breakfast should be served as early as pos¬ 
sible after the child awakens, as he is usually 
hungry at this time of day. Many children eat 
more for breakfast than for any other meal. 
Cooked cereal with boiled milk, toast and butter, 
and orange juice or some stewed fruit furnish an 
ample and wholesome breakfast for children of 
any age. The cereal and fruit need not always be 
the same ones and thus variety is afforded. Oc¬ 
casionally, a poached or boiled egg or a piece of 
crisp bacon may be served also. 

Dinner. —Until six years of age a child’s 
heavy meal should be at noon. This should con¬ 
sist of meat or meat soup, one or two green 
vegetables, a baked potato or boiled macaroni, 
toast, and a simple dessert, as cooked fruit, 
custard, or plain pudding. If the child has 
milk for breakfast and supper none need be 
given at noon. Caution should be exercised 
not to allow too much milk. Invariably, where 
the child has unlimited quantities of milk, his 


MOTHER AND CHILD 159 

appetite for vegetables and cereals suffers. By- 
permitting no milk at dinner, a child can be 
induced to eat other necessary foods. 

Lunch.— The midafternoon lunch may be 
given if the child seems to require it. This, 
however, should be simple and small in amount. 
Dry toast, an unsweetened cracker, or bread 
and butter are ample for this purpose. Milk 
should not be given at this hour as it spoils the 
appetite for supper. If he eats too little at the 
supper hour, he tends to waken with hunger 
during the night. 

Suppek.— A child’s evening meal should be 
very simple and easy of digestion. A restless 
night with hideous dreams often follows a heavy 
supper. This meal may consist of a vegetable, 
cottage cheese, toast, and stewed fruit. A cereal 
with milk may take the place of the cheese. The 
hour should be not later than six, so that by 
seven the child may be in bed. No noisy or 
exciting play should intervene between his sup¬ 
per and bed time. The fact that this is the 
only time of the day many fathers can be with 
their children is unfortunate, for the tendency 
is to romp with them in the evening. While 
this contact with the father is beneficial in moral 
and mental ways, it is detrimental from a physi¬ 
cal standpoint. A story or quiet form of even¬ 
ing play should be the rule with young children. 

Habits of Eating.—Most children need to learn 
to masticate food properly, and hard, dry toast 


160 


NUTRITION OF 


is one of the best means of accomplishing this. 
Also, a child must be tanght not to dawdle over 
his meal and to eat anything that is set before 
him. A mother soon learns the amount of food 
he will eat, and, unless this is unreasonably 
small, a larger amount should not be given 
him. An over-large first serving frequently 
destroys the appetite and causes the child to 
leave on his plate the least desired portion of 
his meal. It is far better to give a second help¬ 
ing than too large a first serving. 

FOOD GROUPS 

1. Vegetables —Spinach, carrots, cauliflower. 

2. Protein —Milk, eggs, meat, fish, cheese. 

3. Cereals —Whole wheat, oatmeal, corn meal, rice, bread. 

4. Fats —Butter, yellow suet. 

5. Sioeets —Sugar, jelly, honey. 

6. Fruits —Oranges, tomatoes, prunes, apricots, apples. 

The above table divides foods into six 
groups, covering the necessary food elements 
and including the vitamins. Characteristic 
foods only are listed and each group may be 
considerably enlarged. If a mother will mem¬ 
orize the six headings and serve something from 
each group daily, not allowing a predominance 
of any one group, her family will have a bal¬ 
anced diet. 

Vegetables. —These form one of the most 
important factors of a child’s diet for, as has 
been demonstrated in preceding chapters, they 
contain more minerals and more vitamins pro- 


MOTHER AND CHILD 


161 


portionately than any other class of foods. A 
mother should persist until a child learns to eat 
any vegetable served him. She should not be 



Fig. 30.—Comparative growth curves of a litter of rats fed on different 
breakfast foods. Rats “A” and “B”were fed a cracked wheat, or granules 
made from hard wheat by the old-fashioned process of milling. Rats “C”, 
and “D” were fed a white refined wheat cereal that is sold to the trade as 
coming from the heart of the wheat berry, but which, in reality, is a by¬ 
product of the milling of white flour. Rats “E” and “ F” were fed a toasted, 
flaky corn product manufactured by a special milling process. The diets of 
rats “C”, “D”, “E” and “F” therefore, contained insufficient amounts of 
the water-soluble vitamins. 

satisfied if he likes only the starchy vegetables, 
such as potatoes, macaroni, rice and sweet pota^ 
toes. These are not classed as green or succulent 
vegetables and do not contain the same elements. 

11 




































162 


NUTRITION OF 


At least a half-cupful, measured after cooking, 
of such vegetables as spinach, cauliflower, car¬ 
rots, Brussels sprouts, green beans, peas, beets, 
or asparagus should form a daily portion of a 
child’s noonday meal. A half-cupful may with 
advantage be given also at supper. Canned or 
dried vegetables are much inferior to fresh oiies, 
and should not be used except in cases of neces¬ 
sity. Directions for the cooking of green vege¬ 
tables are to be found in Chapter VIII. Raw 
vegetables should be frequently used. Raw cab¬ 
bage, carrots, beets, celery, onions, and lettuce, 
used singly or in combinations furnish palatable 
and nutritious salads. They should be put 
through the food grinder or finely chopped. 

Raw Vegetable Salad 

1 cup raw carrot 

14 cup raw peanuts or 1 teaspoon peanut butter 

y 2 cup raw beets or raw apple 

Salad dressing to moisten 

The above are finely ground or chopped, all 
the juice being retained, and the whole moist¬ 
ened with a cooked or mayonnaise salad dres¬ 
sing. For younger children, the peanut butter 
is preferable. Celery and onions may be added 
for older children and adults. 

Peotein. —If a child has a pint of milk per 
day he really needs little additional animal pro¬ 
tein. Too much milk is frequently the cause of 
a poor appetite and should be reduced if a child 


MOTHER AND CHILD 


163 


does not eat vegetables willingly. Mothers are 
inclined to look upon milk as a drink rather 
than a food, but it has a high caloric value, 
and if a child’s hunger is satisfied by a 
glass of milk, he will not care for other foods. 
Milk is far from a perfect food and should not 
form the main portion of any child’s diet after 
eighteen months of age. When two years of age 
he may have an egg, or a serving of meat, 
chicken or fish at the noon meal. It is unneces¬ 
sary to give meat the same day that an egg is 
given. The meat should never be fried, but 
may be broiled, boiled, or baked. Liver, heart, 
kidneys, and sweetbreads are preferable to other 
forms of meat. 

Cereals. —These should form a daily food 
and, if we include breads in the list, should be 
given at each meal. A young child should never 
be given hot breads, pancakes, or waffles. These 
form a heavy mass, which is very difficult of 
digestion. Toasted bread and whole grain ce¬ 
reals are preferable. The superiority of freshly 
cooked, whole-grain breakfast cereals over other 
varieties is amply illustrated in the diagram 
shown in Figure No. 30. This represents the 
results obtained from the feeding of young 
rats on various cereals. The first group was 
fed exclusively on a whole-grain wheat cereal, 
milled in the old fashioned wav without adulter¬ 
ation or the application of heat during the 
preparation. The rats so fed lived and made a 


164 


NUTRITION OF 


normal growth. The next group was fed entirely 
on a refined wheat cereal, in the milling of 
Which the germ and much of the bran is 
removed, and the cereal steamed to prevent its 
ready spoiling. The rats on this diet were able 
to maintain life, but made a decidedly subnor¬ 
mal growth. The third group were fed a 
“ready-to-eat” toasted corn cereal, and on this 
diet death resulted in six months. Many mothers 
are tempted to give their families these easily 
served, prepared cereals, and frequently chil¬ 
dren prefer them to the more beneficial kinds, 
but how grave a mistake is made in so doing 
can be seen from this experiment. Occasion¬ 
ally, for variety, a prepared cereal may be 
served, especially during the summer season, 
but the deficiency should be counterbalanced by 
an abundance of whole-grain breads. 

Fats. —Butter is the most superior fat for 
children and few suffer any disturbance from 
its use even though given freely. There is no 
better growth-promoting agency than pure, 
fresh butter. If the minimum amount a child 
should have, one cubic inch per day, cannot be 
consumed upon bread, it may be used to season 
fresh vegetables, or baked potato. In cases 
where a child has an idiosyncrasy to milk and 
and cream, as not infrequently happens, butter 
may be served on the hot cereal instead of milk. 
Yellow beef fat is not indigestible and contains 
the A vitamin in goodly amounts. This forms 


MOTHER AND CHILD 


165 


a very good butter substitute in the seasoning 
of vegetables, and makes a very palatable addi¬ 
tion to many of them. 

Sugars. —Sweets are permissible in a child’s 
diet, though we must remember that it is very 
easy to overload the system in this respect. No 
sweets should be permitted between meals nor 
until the substantial portion of the meal has been 
eaten. A little honey on toast is a very satis¬ 
factory dessert. Home-made jellies may also 
be used in this way. Sugar should be sparingly 
used, if at all, on the breakfast cereals. Candy 
may occasionally be given at the close of the 
meal, if a satisfactory amount of other food 
has been eaten. Most children have apparently 
a natural liking for candy and other sweets, and 
if these are withheld too stringently, as the 
child becomes older, he frequently will stoop to 
any means of obtaining them. Such an unwhole¬ 
some desire can be avoided by a moderate indul¬ 
gence in sweets from the second year or so. 

Fruits. —Fruits are necessary in a child’s 
diet for the anti-scurvy vitamin, for their laxa¬ 
tive effect, and as appetizers. There is some¬ 
thing so heavy and unnatural in a diet lacking 
fruits that we often find children who partake 
of such a diet sluggish, both mentally and phy¬ 
sically. Fresh fruits are better than canned 
ones, but, except for orange juice, should not 
be eaten raw by infants. Apples are one of the 
first fruits to be given uncooked, and scraped 


166 NUTRITION OF 

apple may be given quite early. Pineapples, 
pears, bananas, and some varieties of berries 
seem difficult of digestion in many instances, 
and should be withheld where this is the case. 
Melons, grapes, and sweet cherries may be given 
older children in moderate amounts when not 
over or under ripe. The seeds should be re¬ 
moved for the child until he is old enough to 
do this himself. 

Liquids. —Children should be encouraged to 
drink an abundance of water. This is a very 
effective means of keeping the system free of 
waste and disease. Too much need not be 
allowed at meal time, and it should not be em¬ 
ployed to wash down half-chewed food. The 
following rule should be well instilled: ‘ 1 Never 
drink when you have food in your mouth. ’ ’ This 
applies, equally to all drinks including milk. 

Cocoa .—Hot chocolate or cocoa for break¬ 
fast is not at all essential for a child, but may 
occasionally be given. It furnishes a. sweet 
drink and the chocolate contains an oil that 
is heavy and indigestible for some persons. In 
making it, milk is generally used, which adds to 
the child’s daily milk quota. The idea that a 
child must have some hot drink for breakfast 
is an erroneous one. A bowl of hot cereal fur¬ 
nishes sufficient warmth in his food. 

Tea and Coffee .—'These contain stimulating 
drugs that are very harmful to the young, caus¬ 
ing nervousness and dyspepsia. A child who 


MOTHER AND CHILD 


167 


is not allowed to acquire a taste for tea and 
coffee will not care for them. Neither should be 
given, except in cases of illness, when they are 
sometimes permissible as a medicine. 

Treats.— Nuts are of high caloric value, but 
are difficult of digestion by young children; 
they should not be given until the child 
has all his teeth, and then only in small 
quantities and under supervision, that they may 
be properly masticated. 

Soda Fountain Drinks and “Sundaes,” 
sweetened with heavy syrups, containing va¬ 
rious fruits, nuts, and ice cream, should never 
be permitted to young children. Plain ice 
cream may be given safely to a child of thr ee, 
provided it is known to be pure and cleanly 
made. Commercial ice creams, especially those 
made by wholesale companies, may be far from 
desirable. A simple fruit or custard dessert, 
easily and quickly frozen at home, furnishes 
a wholesome food and a deserved treat if not 
given too often. 

All of these special treats for children 
should, of course, follow a regular meal. If 
given between meals or on an empty stomach, 
they are more likely to cause trouble 
than when they come at the close of a well- 
balanced meal. 

Care of the Teeth.— By the time a child is three 
years of age, he should be caring for his own 
teeth, and should realize the necessity for clean- 


NUTRITION OF 


168 

ing them just as he knows he must wash his 
hands. The nightly preparation for bed should 
include a careful, thorough brushing of the 
teeth, under the mother’s supervision. By at 
least the third year, regular periodic visits 
should be made to a competent dentist who will 
quickly detect any irregularities or any signs 
of decay. These can then be cared for with little 
or ho discomfort to the child and the ills that 
arise from decayed teeth will be avoided. The 
former belief that it was foolish to have tempo¬ 
rary teeth tilled has changed to a realization of 
the necessity for doing so. The first teeth should 
not be removed too early, as the remaining ones 
tend to till in the space thus made. This inter¬ 
feres with the eruption of the permanent teeth. 
When the first teeth become loose by the resorp¬ 
tion of their roots, due to the growth of the 
permanent teeth beneath, they should be 
removed, or the new ones will erupt in irregular 
positions. We have mentioned previously how 
a child should masticate a piece of hard, dry 
toast each day in order to develop his jaws and 
widen his arches. If this is done from infancy, 
and there are no adenoids to interfere with 
normal development, usually the teeth begin 
to separate about the third or fourth year; 
the space between the little first teeth increases 
until it is half as great as the width of the teeth 
themselves. This is necessary, as the first 
teeth are only two-thirds as wide as the perma- 



Fig. 31. —Impressions of a child’s mouth in which the temporary teeth were allowed 
to decay and were extracted many years too soon. This results in a failure of the jaws 
to expand. When the larger permanent teeth erupted, there was insufficient space, hence, 
their crowded and twisted positions (Bottle-fed in infancy). 











. 





* 
















































































- 


















MOTHER AND CHILD 


169 


nent ones. If a parent notices that they are not 
separating during the fourth and fifth years as 
they should, then artificial means must be 
adopted to accomplish this. More hard food 
requiring extra exertion by the teeth should 
be given and, in addition, special exercises may 
be employed. One that is recommended by 
dentists is having the child insert a wide strip 
of heavy rubber between the teeth. An adult 
then holds this firmly, while the child pulls 
backward with his teeth. This has accom¬ 
plished measurable results even in cases where 
the teeth had already erupted in irregular posi¬ 
tions. At about six years of age, the first per¬ 
manent teeth appear known as the “six-year 
molars.” These erupt back of the temporary 
molars, and many parents fail to note their 
appearance or appreciate that they are perman¬ 
ent teeth. Because of this we find that very 
often a child sacrifices two or more of these 
first molars at an early age. This is a grave 
mistake, for they are the keystones for the 
arrangement of all the other teeth. If they 
are removed, the second, or twelve-year molars, 
push forward to fill the space left vacant, with 
a resultant irregularity in their positions that 
interferes seriously with proper mastication. 

SCHOOL AGE 

Upon entering school, the child undergoes 
many changes in his life. Among these his 


NUTRITION OF 


170 

habits of eating have a share. Often the appe¬ 
tite increases to a marked degree, due to regu¬ 
larity of habits, healthful play, and his new 
mental activities. 

Meals.— The breakfast hour, in some cases, 
must be earlier though the breakfast should 
remain very much the same in quality, but 
increasing in quantity according to the appetite. 
No child should be allowed to rush off to school 
with his breakfast half-eaten. If necessary, the 
adults of the family must sacrifice a little morn¬ 
ing sleep, in order to give the children ample 
time for a full and substantial breakfast. 

Lunch. —The main change lies in the fact 
that usually a child’s dinner must now be given 
in the evening, rather than at noon as pre¬ 
viously. There is seldom time at the noon 
intermission for a child tO| come home, eat a full 
dinner and return to school, without undesir¬ 
able haste. Hence it is preferable to have him 
eat a simple, wholesome lunch leaving the full 
meal until evening. The lunch should be warm. 
A bowl of soup, dish of rice, or a hot vegetable, 
with bread and butter and some fruit are admir¬ 
able for this purpose. The midday lunch of 
the school child should include but little meat, 
as this requires such a long period of digestion 
that the blood needed for the brain is drawn to 
the stomach. If the school is at a distance, 
so that the child must carry his lunch, the mother 
should give thought and care to solving the 


MOTHER AND CHILD 171 

problem of a nutritious, substantial school 
lunch. Sandwiches of whole-wheat bread and 
butter with a wholesome filling are the most 
satisfactory cold lunch a child can have. Pea¬ 
nut butter, nut and fruit marmalades, a thin 
slice of meat, with lettuce or tomato added, 
cottage cheese, or chopped celery and nuts, all 
furnish, toothsome and nutritious fillings for 
sandwiches. Lettuce or celery may be com¬ 
bined with almost any other filling, thus fur¬ 
nishing the minerals and raw vegetable needed. 
In addition to the sandwiches, an apple or 
orange and a small piece of plain cake or a 
cooky make a fairly complete lunch, both from 
the standpoint of calories and vitamin require¬ 
ments. A child should never be given money 
and allowed to purchase his own lunch, unless 
it be at a cafeteria in the school building 
under proper management. If he is allowed 
to go to some nearby confectionery for his 
noonday meal he will be more likely to spend 
his money for dill pickles, candy, ice cream, 
pastries, or peanuts, than for vegetable soup 
or sandwiches. 

Dinner.— With a lunch at noon when he has 
been accustomed to dinner at that hour, the 
child usually is hungry after school, but he 
should be discouraged in his desire to eat upon 
reaching home. To assist in this, the young 
school child should not be expected to wait until 
the family dinner hour if this be late, but should 


172 NUTRITION OF 

be given his dinner between 5 and 6 P.M. He 
should then be ready for bed not later than 
seven-thirty. His evening meal should now be 
much the same as his noonday dinner has for¬ 
merly been. It should be substantial, ample to 
satisfy his hunger, and adequate in vitamins 
and minerals. The strain of school life de¬ 
mands a great deal of nervous energy, and 
the nerves should be well supplied with absorb¬ 
able minerals, these are best obtained from 
green vegetables. 

Variety and Amount.— As the child grows 
older, he may be allowed a greater variety of 
foods and may eat with the family at dinner 
provided the food is not too highly seasoned. 
From eight to twelve years of age many chil¬ 
dren grow tall, losing all the roundness and 
plumpness of their earlier years. This rapid 
growth calls for an increase in calories. Many 
a fast-growing boy seems never to have his 
hunger completely satisfied, and will consume 
several times the amount of food that his 
father eats. This inordinate hunger should be 
appeased by substantial, adequate meals, un¬ 
stinted in quantity and including a fair amount 
of carbo-hydrates. 

Acute Indigestion. —Both older and younger 
children are prone to sudden attacks of indiges¬ 
tion, following indiscretions in diet or from com¬ 
mon “colds.” The infection from the nose and 
throat will often travel to the digestive organs 




MOTHER AND CHILD 


173 


and cause an upset stomach. Vomiting and 
diarrhoea, are the usual manifestations, generally 
with a sudden onset in the middle of the night. 
There may be a more or less elevated tempera¬ 
ture and even delirium or convulsions. There 
should be no interference with nature’s effort to 
rid the body of food that has proven obnoxious. 
She may be assisted in this by having the child 
drink freely of lukewarm water. No cathartics 
should be given, as, they cause an irritation 
of the mucous membrane lining the digestive 
tract. A warm, soap-suds enema may be 
employed, provided the bowels are not acting 
freely or if there seems to be gas present. 
Abdominal pain can be relieved by the appli¬ 
cation of hot cloths. Cold compresses, applied 
to the forehead, are beneficial in reducing a high 
temperature or relieving delirium. Sponge 
baths, also reduce the fever by cooling 
the skin and by opening up the pores for 
the elimination of waste. All food should 
be withheld during the continuance of the 
vomiting, water only being allowed. Sometimes 
even this cannot be retained. Strong hot tea, well 
sweetened, and given without milk or cream, is 
beneficial in quieting the reflex vomiting, which 
is prone to continue long after the stomach has 
emptied itself of all food. Four hours after 
the tea is given and retained, other food may 
be cautiously administered. For this purpose, 
the starches in the form of cereals and toast, fats 


174 


NUTRITION OF 


in the form of butter, and sweets in the form 
of Karo syrup or sugar are advisable. This 
should be accompanied by an abundance of 
water. No vegetables, fruits, milk, or eggs 
should be allowed for at least twenty-four hours 
after the vomiting has ceased. 

Constipation .—If severe or of long standing, 
a physician should be consulted as to the correc¬ 
tion of constipation. A mother needs to know 
how to prevent the development of this condi¬ 
tion, and then she need not worry about its cure. 
Whole-wheat cereals and breads, corn bread, 
fresh fruits, adequate amounts of water, and 
bulky green vegetables all have a beneficial effect 
in preventing this condition or in relieving it. 
The fruits that are especially beneficial are 
prunes and figs. Massage of the abdom¬ 
inal muscles, plenty of outdoor exercise, and 
regular habits as to bowel evacuation will tend to 
prevent or correct the trouble. Milk causes 
constipation with some children, as do also pork 
fat, rich gravies and heavy cream. If a child 
has been allowed to develop chronic constipa¬ 
tion it can best be overcome by a well-balanced 
dietary and healthful exercise. 

Treatment of “Colds.” —All mothers have 
some idea as to the treatment of ordinary 
4 4 colds/ ’ Sometimes these ideas are not as sci¬ 
entific as they might be. Cathartics are not advis¬ 
able. If the trouble is severe or if there is fever, 
the child should be put to bed and a light diet 


MOTHER AND CHILD 


175 


maintained. Fresh air is necessary, but the 
patient must be kept warm. A nasal douche of 
normal salt solution, made by dissolving a tea¬ 
spoonful of salt in a pint of boiled water, is the 
best means of relieving the irritation in the nose 
and preventing the spread of the infection to the 
bronchial tubes. A cold compress about the 
throat is also of benefit, and in cases of persis¬ 
tent coughing at night, will relieve the situation 
more quickly than any other treatment. This 
compress consists of one thickness of thin cotton 
cloth and four thicknesses of wool. The cotton, 
wrung out of cold water, is wrapped around the 
neck, and covered with the four layers of dry 
woolen cloth. If the temperature is high or the 
cough persistent, the compress may be renewed 
every four hours. When it is finally removed, 
the neck should be bathed with cold water and 
briskly rubbed dry. The feet should be kept 
warm and care exercised that the child is never 
suddenly chilled upon leaving his bed. Cough 
syrups should not be given, except on the advice 
of a physician, as most cough remedies tend 
to produce indigestion and sometimes cause 
vomiting and abdominal pain. Colds should 
not be neglected or ignored; repeated fre¬ 
quent attacks often lead to heart, kidney, or 
tubercular troubles. 

These directions for feeding the older child 
are largely for the normal individual. With the 
anaemic, underfed youngster, or one suffering 


17 6 nutrition of 

from acute or chronic indigestion, the diet must 
he varied to suit the requirements of the case. 
Every mother should be more concerned about 
the nutrition of her child than any other phase 
of his physical nature, for his whole body and 
even his morals may be affected by improper 
diet. A large percentage of the boys and girls 
who are committed to our state training schools 
are victims of malnutrition. To properly regu¬ 
late the diet of a child through infancy and 
childhood, is probably the greatest preventive 
work possible, both from the medical and 
social standpoints. 




CHAPTER XII 


FAULTY DIETS 

The faces of children are as the open pages 
of a hook npon which are recorded their dietetic 
histories. There are certain tell-tale evidences 
of unbalanced dietaries that are almost always 
visible in the face, form, disposition, and habits 
of the innocent victims. In the poorer sections 
of our cities one expects to meet the little under¬ 
fed members of the ignorant and poverty- 
stricken households. In some instances, par¬ 
ents have not the means of providing a complete 
and well-rounded ration for their children, nor 
have they the knowledge of what constitutes a 
proper diet for the growing child. The poor 
results in physical manhood and womanhood 
which these homes produce are, in a measure, 
excusable. We must look to the public schools, 
with their health instruction and physical exam¬ 
inations, to correct these in the next generation; 
and to the infant welfare clinics and other 
health centres to give the present generation 
some of the fundamentals of child feeding. The 
sadder story, however, lies in the fact that, not 
alone among the poor and foreign families do 
we find these undernourished and improperly 
fed children, but they appear almost equally 

12 177 


178 NUTRITION OF 

often in well-educated and well-to-do families. 
The children of the latter class have, in addi¬ 
tion, the handicap of a lower resistance to dis¬ 
ease than have those of the slums. Malnutrition 
in the well-to-do comes from indifference, over- 
indulgence, or wrong instruction, any one of 
Which furnishes a barrier to the correction of 
the trouble. 

ERRORS IN INFANT FEEDING 

Starch and Sugar Excess.— The faulty feeding 
of infants is very common and may take various 
forms. The too-frequent ingestion of food, 
which is perhaps the most common error, has 
been dealt with in a previous chapter and need 
not be reconsidered here. Next in frequency 
is the error of overfeeding with starches. This 
is usually in cases where a patent food, con¬ 
densed milk, oatmeal gruel, or some other 
starch mixture has formed an almost exclusive 
diet for months. A case of this type frequently 
develops when a buttermilk formula is too long 
continued. The infant overfed on carbohy¬ 
drates may appear fat and well nourished, due 
to a retention of water in the tissues, but after 
a time a stationary weight results, followed 
later by a distinct loss in weight. The recov¬ 
ery of such a child is slow and discouraging, and 
the case should always be placed in the hands 
of a competent specialist. If breast-milk can- 


MOTHER AND CHILD 


179 


not be obtained, then a correctly modified cow’s 
milk mixture must be resorted to. A child who 
is much overweight during the first year, almost 
invariably falls considerably below normal 
weight at some time before he reaches five years 
of age. 

Whole Milk Diet. —An infant fed exclusively 
on whole cow’s milk may appear to do well for 
a time, but later may develop many and varied 
difficulties'. There is one type, usually the fair¬ 
haired, thin-skinned infant, who shows a marked 
idiosyncrasy to large amounts of milk. This 
type is afflicted with various skin affections, such 
as scaly scalp, eruptions on cheeks, forearms, 
and calves, together with a ready excoriation 
from wet or soiled diapers. The urine often 
has a strong ammonia odor and may leave a 
pinkish discoloration on the clothing. The 
stools are difficult, infrequent, a dirty-gray in 
color, of a hard, stone-like quality, and roll out 
of the napkin like marbles, leaving no stain. 
This is known as the “soap-stool” due to the 
large amount of alkali it contains. The min¬ 
eral content may amount to 48 per cent, of the 
dried stool. At times it is even greater than 
the amount of mineral ingested with the food, in 
which case the reserve mineral supply of the 
body is rapidly exhausted. Rickets and nervous 
disorders are almost invariable results. This 
form of indigestion is usually due to the fat in 
the milk, although the protein may be the causa- 


180 


NUTRITION OF 


tive factor. The remedy, if the child is to re¬ 
main on this diet, is to modify the milk with 
carbohydrates and, occasionally, it is also neces¬ 
sary to remove all fat. No infant should ever 
be given an exclusive diet of whole, unmodified 
cow’s milk. 

ERRORS IN CHILD FEEDING 

So much, in brief, may be said of improper 
infant feeding. In the case of older children 
there are many one-sided diets consumed, due 
to ignorance, weakness in discipline or incorrect 
ideas of nutrition. These often work untold 
harm to the growing boy or girl. 

Fat Excess.— Of the various forms of unbal¬ 
anced diets in older children, probably the exces¬ 
sive use of fat is least common. However, those 
who deal with nutritional disorders occasionally 
find marked examples of this disturbance. Pork 
fat is the usual offender, and, naturally, more 
often occasions trouble in country homes where 
large quantities of pork are consumed. As in 
the infant, eczematous or other eruptions of 
the skin with constipation are among the notice¬ 
able symptoms. The resulting dyspepsia with 
a marked intolerance for all fatty foods may 
continue for years. Fatty meats, such as pork 
and sausage are indigestible for practically all 
children and, since they are lacking in vitamins, 
had best be omitted altogether. This does not 
include yellow beef fat, which is rich in vita- 


MOTHER AND CHILD 


181 


mins. Seldom do we find a child who cannot 
digest butter in moderate amounts, though 
heavy cream may need to be removed from 
the diet. 

Sugar Excess.— No doubt an excessive amount 
of carbohydrates both starch and sugar, is one 
of the most common errors made in the feeding 
of older children. White breads, cereals heav¬ 
ily coated with sugar, which is frequently re¬ 
newed once or twice during the consumption 
of the serving, rich pastries, frosted cakes, cheap 
and easily obtained candies, made especially for 
the child-trade, honey, syrup, jams, and jellies, 
all furnish an alarmingly high percentage of 
sugar. The hunger being satisfied with sweets, 
the jaded appetite refuses to partake of more 
substantial foods. From an excessive use of 
sugar, many a child is nervous, thin, sallow, an; 
semic, and irritable, with an undersized body, 
diseased tonsils, decayed teeth, foul breath, con¬ 
stant “colds” and general debility. None 
except drastic measures can overcome the sugar 
habit when once well established with a young¬ 
ster. Usually such a child has been so coddled 
and spoiled that reasoning does little good. 
Sometimes starving for a few meals is neces¬ 
sary before he is willing to partake of whole¬ 
some food. The surest and quickest means of 
accomplishing a cure is to take the child to the 
country, far away from confectioners, where he 
may have plenty of outdoor life to induce a 


NUTRITION OF 


182 

normal appetite and an abundance of whole¬ 
some food to satisfy it. Insist on the child’s 
eating a goodly amount of vegetables, fruits, 
and whole-grain cereals before sweets or des¬ 
serts are permitted. If the country is not avail¬ 
able, a sojourn of two to four weeks in a hospital 
under proper dietetic supervision is the next 
best remedy. With older boys, the strict dis¬ 
cipline and outdoor life of a boy’s camp will 
almost invariably effect a cure. 

Protein Excess. —It is a comparatively easy 
matter to persuade mothers of the mistake of 
overfeeding with sugar, but quite a difficult one 
to convince them of the error of an excessive 
amount of protein. The results of protein ex¬ 
cess, however, are as grave and often more dis¬ 
astrous than those from excessive carbohy¬ 
drates. The free use of milk and eggs easily leads 
to protein, extravagance. Children who have 
been bottle-tfed in infancy are far more 
sensitive to protein excess than are those 
who have been breast-fed. The white of 
egg, our purest and most concentrated form 
of protein, is not readily assimilated by 
many children. Magazine articles and popular 
lectures have long heralded milk as the perfect 
food, easily digested, and cheap in comparison 
with meat, fruit, vegetables, and even bread. 
Advertisements of dairies, conspicious on sign¬ 
boards, in street cars, and local papers, admon¬ 
ish mothers to 1 ‘feed their children nature’s 



MOTHER AND CHILD 


183 


own food—fresh, rich milk” and present the 
apparently convincing illustration of a robust- 
looking infant beside a full bottle. Health-cen¬ 
tres have tended to over-emphasize milk in order 
to induce certain mothers to use it at all. In 
view of all this publicity, it is not surprising that 
the general public very reluctantly relinquishes 
this firmly established belief that milk is the 
one perfect and essential food for growing chil¬ 
dren. No doubt many poorer homes are unduly 
stinted in their milk supply, but it is equally 
true that children in general, consume far too 
much milk. Governmental and other food ex¬ 
perts, who formerly advised a quart of milk 
daily for each child, now recommend a pint as 
entirely adequate. Protein excess develops 
either a phlegmatic, overweight child, lacking 
a corresponding development of muscle and 
nerve tissue, or a thin, nervous, underweight 
specimen, subject to various acute disturbances. 
Chronic eczema is one of the results of excessive 
protein. This may be so mild as to be consid¬ 
ered only an irritation of the skin due to the 
wind and sun. This form of eczema is charac¬ 
terized by a bright redness of the cheeks, often 
more pronounced upon one cheek than the other, 
roughness of the skin, and occasionally minute 
red blotches. There may be also an irritation 
behind the ears and in other folds of the skin. 

Asthma.—Another affection rarely attributed 
to dietetic causes is asthma, yet the “ingested” 


NUTRITION OF 


184 

form of this disease is due entirely to wrong 
feeding for that particular individual case. An 
excess of milk or eggs are the two most common 
causes, with oatmeal a poor third. In numerous 
cases of both eczema and asthma in children, the 
most effective treatment consists in a regula¬ 
tion of the diet, usually discontinuing eggs and 
milk altogether for a time, then reinstating in 
very small quantities and increasing gradually. 
One severe case of chronic “bronchial asthma” 
in a little girl nine years of age is typical; prac¬ 
tically all her young life she had been a victim 
of this distressing affliction; expert care and 
treatment had been accorded her, thousands of 
dollars had been spent trying to find a climate 
that would be beneficial or a cure that would be 
effective. Her daily diet contained eggs and 
from two to three quarts of milk. When she 
was able to attend school which was very irre¬ 
gularly, she carried milk to drink at recess. 
The treatment instituted was wholly dietetic. 
Eggs were eliminated, milk was reduced and 
later removed entirely. A diet adequate in 
calories was prescribed, consisting of fruits, 
whole-grain cereals, whole-wheat bread, meat, 
butter, and an abundance of green vegetables. 
The child responded wonderfully and in a few 
weeks was experiencing no more trouble with her 
enemy—asthma. X-ray pictures of the chest 
which formerly revealed a marked thickening 
along the bronchial tubes, later showed a decided 


MOTHER AND CHILD 


185 


improvement in this condition. She gained 
rapidly in weight (nine and three-fonrth 
pounds in five months). The pinched, drawn 
look about her nose and mouth disappeared; the 
red, eczematous cheeks became softly rosy and 
smooth; her disposition changed from a nervous 
snappy, petulance to that of a quiet, hearty, 
normal child. 

General Effects .—An excess of milk not only 
works a pernicious influence in a positive way, 
but likewise has a negative influence that is 
equally harmful. Milk is a ready-made, liquid 
food, which calls for no exercise of the organs of 
mastication; an inadequate development of jaws 
and teeth results. By satisfying a child’s cal¬ 
oric requirements, so that he does not feel the 
need of other food, he comes to subsist largely 
upon milk, and doesn’t learn to eat vegetables 
and cereals. In practically every case where 
a mother complains that her children will not 
eat vegetables, they are found to be drinking 
milk freely. Any child can be taught to like 
vegetables, provided a proper limit is placed 
upon his ingestion of milk, eggs, and sweets. 
A pint of milk a day is all any child over 18 
months of age needs. Eggs had better be omitted 
from the diet of children under two years of age; 
after that time one to four eggs per week 
may be allowed. 

Lunches.— The between-meal lunch is a per¬ 
nicious habit in many homes, resulting in an 


186 


NUTRITION OF 


almost constant nibbling at sweets, crackers, 
bread and butter, apples, nuts, and ice cream 
cones. As a result a child’s appetite is jaded 
and, when he comes to a properly balanced meal, 
he is with difficulty persuaded to eat at all. 
Plain foods have no appeal for him, and he is 
willing to consider only such as are highly sea¬ 
soned or sweetened. In a few hours he is again 
hungry, and demands other lunches before the 
next regular meal time, and so the vicious cir¬ 
cle progresses. One mother had often com¬ 
plained that she could not induce her little 
daughter to eat wholesome food. The child was 
much underweight, had badly decayed teeth, and 
was extremely nervous. The following is a 
sample of her daily diet: Breakfast, consisting 
of hot cakes and syrup, was eaten hurriedly so 
as not to be late to school. At noon she rushed 
home and lunched upon coffee and bananas, 
eaten from the pantry shelf. After her release 
from school, in the afternoon, she ate almost 
continuously of apples, candy, nuts, popcorn, 
bananas, and cookies. At dinner, the first 
wholesome meal of her day, she merely nibbled 
at her food and went to bed without having 
met any of the food requirements of her body, 
except possibly that of calories. This was in a 
home of more than average means, in which 
the children were denied nothing. Not many 
mothers commit such flagrant errors in child 
feeding, yet many are at fault to a lesser degree. 

Perversions of Taste.—Occasionally we meet 


MOTHER AND CHILD 


187 


a child whose taste is so perverted by improper 
training or wrong diet that there is an inordinate 
craving for minerals, such as excessive amounts 
of salt and lime. Cases are not uncommon of 
girls nearing puberty, who devour blackboard 
chalk or plaster dug from the walls, and of 
younger children who eat earth with avidity. 
These perversions of appetite in children, men¬ 
tally normal, simply indicate a marked defi¬ 
ciency in those minerals which the body requires 
for development and growth. A complete, 
wholesome, and well-balanced diet is the only 
cure for such abnormal habits and desires. 

Corrective Measures.— Parents who realize the 
inadequacy of a child’s diet often allow it to 
continue unchanged because of the difficulty 
involved in trying to correct it. It is beyond 
question a difficult matter to reform a child’s 
tastes and to substitute for a one-sided diet a 
well-balanced one. Firmness of conviction and 
purpose, even with strict discipline, will not 
always accomplish the desired end. A mother 
may remove the undesirable ration and intro¬ 
duce a proper one, but many a child will go 
hungry rather than eat food for which he ima¬ 
gines he has a dislike. It’s the old story of 
leading a horse to water but not being able to 
make him drink. Starving a child for a meal 
or two will accomplish results in many cases. 
The mother must see that the child has suffi¬ 
cient outdoor exercise to induce a proper appe¬ 
tite, and that this is in no way appeased by 


188 


NUTRITION OF 


lunches or by sweets, until he has eaten a whole¬ 
some meal. If reasoning and persuasion fail, 
then more subtle methods must be devised. 
Rewards may be given or pleasures withheld 
according to the results obtained. Praise of 
the food by other members of the family has a 
beneficial psychological effect; parents can 
hardly expect a child to eat what they refuse. 
Sometimes a child who eats alone acquires very 
limited tastes, and this may be overcome by 
placing him at table with adults, provided the 
food served is suitable for a child’s consump¬ 
tion. For the sake of their children, parents 
will often simplify their own diets, with resul¬ 
tant benefit to themselves. Sometimes the par¬ 
ents need disciplining more than the children, 
and frequently a grandmother is the chief source 
of the trouble. In some homes 4 ‘ grandmother- 
itis” is one of the greatest hinderances to the 
application of modern, scientific methods in the 
feeding of children. Fantastic games and fairy 
tales may be devised to accompany the disap¬ 
pearance of the unwelcome food. Likewise, the 
wonderful story of the digestion and assimila¬ 
tion of food by the cells of the body, and a des¬ 
cription of the various needs of these cells will 
usually awaken an older child’s interest and 
enthusiasm. A change to country or seaside is 
often a successful means of inducing a child 
to eat wholesome food; equally effective is 
placing him under authority other than that of 
the parents. 


CHAPTER XIII 


SOME COMMON FALLACIES IN THE CARE 
AND FEEDING OF CHILDREN 

Through the centuries past there have 
grown up many erroneous ideas in regard to 
the care of children. The innocent victims of 
these fallacies have, as a consequence, suffered 
pain, inconvenience, malnutrition and, at times, 
even death itself. Some firmly-held miscon¬ 
ception or superstitution regarding child-care 
can render a scientific regime in diet ineffective. 

Dress. Bands. —The infant’s abdominal 
band is a valuable support and protection to the 
dressings of the cord and an aid in keeping the 
abdomen warm. As soon as the navel is 
entirely healed, the abdominal binder should be 
discontinued and the band with shoulder sup¬ 
ports be adopted. A binder which may be only 
comfortably snug when adjusted, may become 
so tight after a full feeding as to cause pain 
and serious interference with digestion. The 
binder is a pernicious thing if worn too tightly; 
it not only causes discomfort, but if too long 
continued, materially weakens the abdominal 
muscles and frequently results in hernia. 

Woolens.— Many adults are sensitive to 
wool, and infants, with their soft, tender skins, 
are nearly always irritated by contact with 

189 


190 


NUTRITION OF 


woolen undergarments. More babies are over¬ 
dressed than otherwise and the poor little 
things, in their effort to make their discomfort 
known, are fed and coddled and made more un¬ 
comfortable. Crying that is considered the evi¬ 
dence of colic or insufficient food often is 
occasioned by too much clothing. Many babies 
are covered with a fine, red rash from this cause 
alone; naturally they are irritable and discon¬ 
tented. Except for stockings, it is advisable 
to use no wool next to the skin of an infant. 
Many of the best hospitals use only cotton gar¬ 
ments on new-born babes. If wool is desired, 
it should be used over the cotton. 

Heliotherapy or The Sun Cure .—Older chil¬ 
dren are also frequently over-dressed. Many 
youngsters four or five years of age wear woolen 
undergarments throughout the summer months. 
Cases of malnutrition which are slow in respond¬ 
ing to treatment, often begin to show improve¬ 
ment as soon as the amount of clothing is reduced 
During the summer youngsters may well 
be dressed very scantily. They soon become so 
accustomed to the air upon their bodies that they 
are not cold, even on cloudy, damp days. Im¬ 
proved circulation in the skin gives it a warm 
feeling similar to that occasioned by a fever. As 
soon as the body is exposed to the sun and air, 
the nutrition of the child always shows remark¬ 
able improvement. Typical results were ob¬ 
tained in a four year old boy, who was suffering 



Fig. 32.—Boys dressed only in trunks and sandals 
playing in the snow. 



Fig. 33. —Impression of child’s mouth 
showing the irregular, protruding teeth and 
receding chin, due to thumb sucking and 
early loss of first molars. If not regulated 
by artificial means, the condition will be¬ 
come progressively worse as more permanent 
teeth crowd into the insufficient space. 
(Bottle-fed in infancy). 


























MOTHER AND CHILD 191 

from a severe malnutrition and anaemia. He had 
been in the habit of sitting listlessly for hours, 
showing no interest in things around him and no 
desire to enter into the play of other children. 
Correction of his diet resulted in little improve¬ 
ment. As it was midsummer, the parents were 
advised to allow him to play in the sun, dressed 
only in trunks and a straw hat. Within three 
weeks he was an alert, wide-awake, normal child, 
with a keen appetite for food and for play. His 
anaemia was rapidly disappearing, and he had 
gained two pounds in weight. The father 
became so enthusiastic over the results that he 
allowed the younger child to dress in a similar 
manner, and extended the treatment far into the 
winter. The accompanying picture (Fig. 32), 
shows the two boys, in their scant raiment, glee¬ 
fully rollicking in the December snow. 4 ‘Back 
to nature” applies as well in clothing as in food 
or exercise. 

Antiseptics.— When the destructive power of 
certain drugs over germs was first discovered, 
surgeons began operating in a spray of carbolic 
acid. Many a patient, as well as doctor, lost 
his life through carbolic acid poisoning. The 
remedy was worse than the disease. It was 
then discovered that absolute cleanliness of in¬ 
struments, hands, and parts adjacent to the 
wound was all that was necessary to prevent 
infection. This was obtained by sterilization 
and was termed asepsis. 


192 


NUTRITION OF 


Navel. —The same truth applies in the care 
of infants. Many nurses and some doctors 
deem it necessary to use antiseptics lavishly in 
the care of new born babies. Neither boric acid 
nor any other antiseptic should be used on the 
freshly cut cord. Their use results in an irri¬ 
tation of the parts and produces granulation 
tissue, which bleeds easily and causes the navel 
to be very slow in healing. Recently, an infant 
was seen shortly before its death, who had a 
deep ulcer at the navel, surrounded by an 
inflamed area fully two inches in diameter. The 
non-professional attendant at the time of birth 
had freely applied a strong antiseptic in dress¬ 
ing the cord. This caused an irritation of the 
skin which permitted germs to enter. The 
autopsy showed that the infection at the navel 
had caused death. The best treatment for the 
cord is the use of dry, sterile dressings renewed 
daily or whenever soiled. 

Mouth and Nipples. —A few years ago it was 
considered necessary to swab out the infant’s 
mouth with boric solution every day. As a 
result many a poor little victim developed a sen¬ 
sitive mucous membrane which was susceptible 
to all sorts of infections, notably thrush. A 
well baby’s mouth needs no cleansing. In like 
manner, boric solution is often applied to the 
mother’s nipples before and after nursing. The 
drug irritates the skin, makes nursing painful, 
and permits infections which cause fissures and 


MOTHER AND CHILD 


193 


bleeding nipples. These are so painful that 
they are not an infrequent cause of weaning. 
If the nipples are bathed with pure, boiled water 
before and after nursing, no further treatment 
is necessary to render them clean before being 
introduced into the infant’s mouth. 

Gargling .—Older children and adults often 
use various antiseptics for gargling the throat, 
in the hope of avoiding the contraction of some 
disease. This continuous gargling produces the 
very result which they aim to prevent. By caus¬ 
ing an irritation of the mucous membranes, the 
person is rendered more susceptible to invading 
germs. The best non-irritating gargle is nor¬ 
mal salt solution, which is made by dissolving a 
level teaspoonful of salt in a pint of water. 

Sleep. —All young children should sleep 
alone and, if possible, in a room by themselves. 
An infant who shares his mother’s bed has 
his sleep interrupted and broken, fusses more 
frequently to nurse, and in many cases does 
nurse, almost continuously, throughout the 
night. A child who has his individual bed is less 
nervous, is more easily trained, and gets a more 
adequate amount of sleep. His bed should be 
in a room which has a goodly supply of fresh 
air, with some protection from strong, direct 
drafts. The day-time naps are best taken on a 
porch; to a child accustomed from birth to out¬ 
door naps there is little danger from cold even 
in quite severe weather provided he is suffi- 

13 


NUTRITION OF 


194 

ciently protected with warm garments. A 
young babe should spend at least twenty hours 
a day in sleep. This is gradually lessened as 
the child grows older, but all children up to nine 
years of age require ten to twelve hours of sleep. 
The very pernicious habit of allowing children 
to keep the same hours as their elders is account¬ 
able for a goodly percentage of nervous dis¬ 
orders. No young child should be taken to an 
evening function which keeps him up later than 
nine o’clock. 


HOURS OF SLEEP 


New-born infant 
At six months .. 
At one year ... 
2-4 years . 

5- 6 years . 

6- 9 years . 

9-12 years . 

After 12 years . 


Hours 
per day 
20-22 
18-20 
16-18 
12-14 
12 

10-12 

10 

9 


Fondling of Infants.— There is nothing in 
all the world more universally appealing and 
altogether adorable than a young babe; and it 
is more to gratify our own selfish delight that we 
handle and fondle them, than for any good they 
may derive from such treatment. Many babies 
come to like it, however, and will cry to be held 
or carried. The extremes to which young par¬ 
ents will sometimes go in their efforts to quiet a 
crying youngster by such indulgent methods are 










MOTHER AND CHILD 


195 


almost beyond belief. One young couple had a 
spoiled child that enjoyed being carried, and 
likewise had a peculiar fondness for headgear. 
This father said in all seriousness that more 
than one night, clad in his pajamas and hat, he 
had walked the floor for hours with that child 
in his arms. 

A weak, poorly nourished child should not be 
subjected to handling, as it uses up energy 
needed to keep him alive. A healthy youngster, 
after it is ascertained that there is nothing 
wrong, may be allowed to cry for an hour or 
two a few times, until he learns that he must lie 
quiet even when awake. A child who is thus 
trained from early infancy, and taken up at 
intervals only for necessary attention, or at 
rarer intervals for relaxation, will develop the 
power to amuse himself; and, when he becomes 
older, will not demand constant entertainment 
by an adult. The handling and fondling habit 
develops a nervous, irritable child that demands 
continual change and excitement. 

Kissing is an abomination not to be tolerated 
by modern mothers. No good results to the 
babe from the habit, and frequently diseases are 
transmitted in this manner. If fond admirers 
must thus indulge themselves, let them kiss the 
top of the babe’s head or the back of his neck. 
Kissing on the mouth or face should not be per¬ 
mitted with young children. With older chil- 


196 


NUTRITION OF 


dren the French custom of kissing on the cheeks 
is permissible. 

Thumb-sucking.—The first movements of 
an infants hands are toward his month 
and he instinctively puts everything possible 
into it. The muscles respond to the stimulus 
and at once begin the act of sucking. The 
mouth is not supposed to work incessantly, how¬ 
ever, and needs rest as much as any other part 
of the body. If worked continuously through 
the habit of thumb-sucking the muscles become 
overdeveloped and draw the soft cartilaginous 
bones out of their normal relationships. The 
arch becomes narrow and high, the front teeth 
protrude, and the nasal passages become 
crowded, giving an ideal opportunity for the 
growth and enlargement of adenoid tissue. The 
adenoid face, with the lips pursed forward in the 
sucking position and no grooves between them 
and the cheeks, resulting in the blank, idiotic ex¬ 
pression so characteristic of a child thus bur¬ 
dened, is familiar to us all. Likewise the teeth 
are misshapen and the hands deformed by the 
thumb-sucking habit. (Fig. 33). The germs 
that enter the system by this means, after the 
child begins creeping, are multitudinous. For 
these several reasons, it is better to prevent a 
child’s forming this habit if possible. If it has 
become quite firmly established, it should not be 
allowed to continue longer than the first 
half-year. 


MOTHER AND CHILD 


197 


Methods. —The child may often be easily 
cured of his thumb-sucking by tying a rubber 
glove finger over the thumb or finger used. 
Sometimes more strenuous methods must be 
adopted, such as a paste-board cuff about the el¬ 
bow which renders it impossible for him to raise 
his hand to his mouth. This should extend from 
above the elbow to the wrist; the ends of the 
shirt sleeve should be pinned back over it, so that 
it may be held in place and the edges of the cuff 
may not irritate the tender skin. Aluminum 
mitts are also of value for this purpose. During 
sleep, the child’s sleeves may be pinned to the 
bed to prevent his raising the hands to the 
mouth. 

“Pacifiers .”—Whatever the evil effects of 
thumb-sucking may be, these are intensified by 
the use of a rubber nipple known asa“ pacifier. ’ ’ 
It is more constantly in use, it is far more 
uncleanly, and the habit is a much harder one 
to correct. More serious defects to teeth and 
jaws come from the pacifier than from thumb- 
sucking. There is never any excuse for the 
forming of this pernicious habit. Who has not 
witnessed a child noisily sucking on a pacifier 
in some public place, when, suddenly, the object 
would roll across the floor; hurriedly the mother 
would recover it and wiping off the most appar¬ 
ent of the filth collected in its journey, instantly 
return the unclean object to the howling child? 
It is hard to imagine a more disgusting practice. 


198 


NUTRITION OF 


Teething.—Abraham Jacobi once said that if 
we judged the causes of death by those given in 
death certificates, more persons had lost their 
lives from teething than from all the wars of 
history. He was the first to point out the fal¬ 
lacy of this idea, and to demonstrate that this 
natural and physiological process is unjustly 
blamed for many of the ills of infancy. Teeth¬ 
ing is no longer accepted by health boards as a 
sufficient cause of disease or death. 

If the child has had his organs of mastica¬ 
tion properly developed by hard food, he will 
suffer little or no disturbance with the eruption 
of his teeth. Children who are unwisely fed 
have latent digestive troubles which become 
acute whenever there is a slight variation in 
their physical condition. There may be an 
increased flow of saliva, due to the local irrita¬ 
tion occasioned by the pressure of the teeth 
against the gums, and the child may exhibit 
some peevishness, but severe symptoms, such 
as fever and diarrhoea, never result from the 
simple physiological process of the eruption 
of the teeth. 

“Second Summek.”— The fear of the second 
summer has long been a well-known bogy. It 
is as unfounded as the erroneous beliefs regard¬ 
ing teething. If a sensible regime has been fol¬ 
lowed in the feeding of a child, there is no more 
occasion for concern regarding this time of a 
child’s life than any other summer season. 


MOTHER AND CHILD 


199 


The reason for the “second summer” fal¬ 
lacy is that many mothers have ceased 
to give sufficient attention to a child’s 
diet at this age. With the coming of hot 
weather, when foods are less sterile and when 
the body’s resistance is lowered because of the 
heat, acute digestive troubles develop easily. 
During the second summer a child often is taken 
about to public places for the first time. He 
goes upon picnics and excursions, mingles in 
promiscuous crowds, eats a variety of undesir¬ 
able and unsuitable foods, all of which leads to 
alimentary troubles. Cases of infectious diar¬ 
rhoea are frequently contracted in this way. The 
observance of a few simple rules will usually 
avoid any such trouble. Additional caution 
should always be exercised during the extreme 
heat of summer in the sterilization and care of 
milk, fruits, and vegetables, as bacteria grow 
so much more readily in hot weather and foods 
spoil so much more easily. Simple home-cooked 
meals, somewhat less in amount during the hot 
season, plenty of pure water, and an avoidance 
of crowds, will usually result in freedom from 
digestive troubles, whether it be a child’s second 
summer or any other. 

Cathartics.— One of the most firmly estab¬ 
lished of the erroneous ideas pertaining to the 
care of children is the one regarding castor oil 
and other cathartics. For every ill of childhood, 
from indigestion to the more serious contagious 
diseases, most parents and some physicians will 


200 


NUTRITION OF 


immediately administer a dose of castor oil. In 
certain instances, the use of this drug is respon¬ 
sible for the death of the child. Where there is a 
hard fight ahead, castor oil depletes the patient’s 
strength and hurries the end. Its rapid action 
is due to its irritation of the mucous membrane 
lining the bowel; for days after the drug is given 
the stools contain red blood cells. The purpose 
in administering the oil is to clean out the large 
bowel; the stomach and small bowel rarely need 
cleansing. The large bowel can be emptied 
much more quickly, safely, and painlessly by a 
warm water enema. How foolish we would con¬ 
sider the housewife who, in order to scrub her 
kitchen floor, would turn the hose in at the front 
door and force the water clear through the house 
to the kitchen. This is exactly what is done 
when castor oil is given by mouth to clean out 
the lower bowel. Even enemas should not be 
used frequently, or the bowel soon learns to 
wait for this extra stimulation. It is not always 
necessary for an infant or child to have a move¬ 
ment daily. Many breast-fed infants so com¬ 
pletely assimilate all the food taken that they do 
not have a sufficient residue of waste matter to 
require a daily evacuation. So long as the child 
indicates no discomfort and the former move¬ 
ments have been normal, a mother need feel no 
alarm should two or three days elapse between 
movements. Chronic constipation must be cor¬ 
rected by some change in the diet, such as, the 
addition of fruit juices, fruit pulp, or green 


MOTHER AND CHILD 


201 


vegetables. Regular habits and massage of 
the abdomen are beneficial also in relieving 
this condition. 

Uncleanliness. Toys. —It is a dangerous and 
pernicious habit to allow small children to ex¬ 
change toys, as they almost invariably introduce 
these at once into their mouths. Infants ’ toys 
should be of such a nature that they can be scrub¬ 
bed frequently with soap and water and should 
be individual possessions. Children should not 
be allowed to pick up playthings found upon the 
street, or elsewhere, and use them without a 
careful cleansing. 

Food. —Children of even fastidious parents 
are permitted to share alternate bites of food 
with companions, and to eat candy or fruit that 
has rolled upon the floor of railway stations and 
other public places. The fruit from a public 
stand should not be eaten without a thorough 
cleansing, as it is exposed to the dust of the 
street and germs from the mouths of passersby. 
There is no better medium for the growth of 
bacteria than fully ripe or partly decayed fruit. 
Many instances of acute minor disturbances as 
well as typhoid, tuberculosis, and influenza have 
originated from contaminated food. Why will 
a parent, fastidious to a degree in respect to her 
own food, permit her child to creep over the 
dirty floor of a public waiting room and pick 
up particles of food? Yet one frequently sees 
this dangerous and disgusting practice. Every 
effort should be made to teach a child, while 


202 


NUTRITION OF 


very young, never to put anything into his mouth 
that is not known to be clean. 

Bedtime Stories.— It is an accepted fact sup* 
ported by psychologists that one of the most 
effective methods of instilling right thoughts and 
habits into a child’s consciousness is by stories 
told at bedtime, when the child's body is quies¬ 
cent and the conscious mind drowsy with sleep. 
The subconscious self, which is then in control, 
may be moulded, by suggestion, into what we 
desire it to be. The mistake is often made, 
however, of relating at this hour tales of thril¬ 
ling adventure and exciting wonder. By such 
stories, the child is wrought up to a nervous 
pitch that often persists throughout the night. 
The bedtime story should be one of Mother Na¬ 
ture, or one illustrating a certain trait of char¬ 
acter desired in the child. It should be told with 
a calm, unimpassioned voice, such as induces a 
quiet restful sleep. At all times the stories 
children hear or read should he suited to their 
ages and to their mental development. They 
are injured by stories which tax their minds, 
just as they are by doing school work that is 
beyond their capabilities. Children who spend 
too much time reading and too little time in 
exercise develop their minds at the expense of 
their bodies. No parent should try to make his 
child too precocious, but should be satisfied with 
a normal mental growth corresponding to the 
physical development. 


APPENDIX 

FOODS AND FOOD COMBINATIONS IN 
ioo CALORY PORTIONS 


C = cup T = tablespoon t = teaspoon 


Pood 

Almonds 
Apples 
Apple sauce 
Apricots 
Asparagus 

B 

Bacon 

Banana 

Beans, navy 

Beans, lima 

Beans, string 

Bean soup 

Beef, round, lean 

Beets 

Biscuits 

Blackberries 

Bread—Graham 

Bread—white 

Brown Betty 

Butter 

Blanc Mange (corn starch) 
Buttermilk 

C 

Cabbage 
Cakes—angel 
Cakes—butter 


Food measured 
as served 

10-15 
1 large 

% c. 

3 large halves, 2 T. juice 
20 stalks, 8 in. long 

Slice 5 x \ y 4 x y 8 in. 

1 large 
1 C. 

1 C. 

2y 4 c. 

1 c. 

3 x 2 y 2 x y 2 in. 
iy 3 C. diced 

2 small 
1 C. 

1 slice 4 x 4 y 2 x y 2 in. 

1 slice 4 x 4y 3 x y 2 in. 
1/5 C. 

1 T. 

Vi c. 
iy s c. 


5 C. shredded 
4 x 2 x 2 y 2 in. 

% x 1 x % in. 

203 




204 


APPENDIX 


Cakes—chocolate 

Cakes—sponge 

Carrots 

Cauliflower 

Cantaloupe 

Celery 

Cheese, American 
Cheese, cottage 
Cherries 
Chicken 

Chocolate (made with milk) 
Cocoa 

Cocoanut, shredded 
Cookies, plain 
Cookies, molasses 
Corn, fresh 
Corn, canned 
Corn bread 
Cornmeal mush 
Cottage pudding 
Cream 16 per cent. 

Cream whipped 
Cream vegetable soups 
Cream of wheat 
Crackers—graham 
Crackers—soda 
Cranberries 
Custard 

D 

Dates, dried 
Date pudding 
Dried beef creamed 

E 


2i/ 2 x 2% x 1 in. 

1 y 2 x iy 2 x 2 in. 

2 C. diced 

1 very small head 
1 melon 4 y z in. diam. 
4 C. of 14 in. pieces 
1 x 1 x % in 
y 2 C. scant 

1 C. 
i/ 4 C. 

% C. 

2/5 C. 

1/5 C. 

3-2 in. diam. 

2-3 in. diam. 

% c. 

Y» C. 

2x2x1 in. 

9 T. 

2x2x2 in. 

y 4 c. 

2 T *. 

% C. 

% c. 

2 % 

4 (large) 

2 C. 

% C. 


4 

1x1x2 in. 
% C. 


Eggs iy 3 


APPENDIX 


205 


F 

Farina 
Figs, dried 
Fondant 
Fudge, chocolate 
French toast 
Filberts 

G 

Gelatin 
Gingerbread 
Grapes 
Grape Juice 
Grape Fruit 

H 

Halibut steak 
Ham, smoked 
Heart 

Hominy grits 
Honey, strained 

I 

Ice cream 
Ices 

K 

Kidney 

L 

Lemonade 

Lettuce 

Liver 


%c. 

3 medium 
1 T. 

iy 2 x % x 1 in» 
3x3 x y 2 in. 

8-10 


4 T. scant 
1x2x2 in. 

1 large bunch 

% c. 

y 2 medium 


3x2x2 in. 

4 x 3 x % in. 

1 oz. 

2 T. 

1 T. to iy 2 T. 


% C. 

% c. 


2 oz. 


1 % c. 

2 medium heads 
2 oz. 





206 

M 


APPENDIX 


Macaroni, with cheese 
Macaroni, with tomato and 
bacon 

Marmalade, orange 
Milk, condensed 
Milk, skimmed 
Milk, whole 
Muffins 

0 

Oats, rolled 
Olives 

Onions, fresh 
Oranges 
Orange juice 
Oysters 
Oyster soup 

P 

Peaches, fresh 
Peaches, canned 
Pears 
Peas 

Pies, apple 
Pies, cream 
Pies, lemon 
Pies, pumpkin 
Pineapple 
Plums 
Pork chops 
Potatoes, Irish 
Potatoes, sweet 
Pecans 

Peanut butter 
Prunes, dried 
Puffed rice 
Puffed wheat 


% c. 

% C. 

1 T. 
1% T. 

1% c 
% c. 
% 


% C. 

5-6 

2 medium 
1 large—2 small 
1 C. 

% c. 

% C. 


3 medium 

2 large halves, 3 T. juice 
2 medium 
% 0 . 

iy 2 in. at circum. 

2 in. at circum. 

1 in. at Circum. 

2 in. at circum 

1 slice—3 T. juice, % C. 
3-4 large 
2x2xi/ 2 in. 

1 medium 
1 small 
12 meats 
2y 2 T. 

5 or 6 
1% C. 

1% c. 


APPENDIX 


207 


R 


Raisins 

% C. 

Raspberries 

1% C. 

Rice (cooked) 

% C. 

Rice with cheese 

% c. 

Rice with raisins 

% C. 

Rice pudding 

y 3 c. 

Rice with tomatoes 

% c. 

S 

Salad dressing, cooked 

4 % T. 

Salad dressing, French 

3% T. 

Salad dressing, mayonnaise 

1 T. 

Salmon, canned 

% C. scant 

Salmon, loaf 

% c. 

Sherbet, milk 

% c. 

Shredded wheat 

1 biscuit 

Strawberries 

1% c. 

Steak 

4x1x1 in. 

Sugar 

2 T. 

Sugar loaf 

3% lumps 

Squash 

y 2 - 3 /4 c. 

T 

Tomatoes, fresh 

3 medium 

Tomatoes, canned 

2 C. scant 

Turnips 

2 C. 

W 

Walnuts 

8-16 nuts 

White sauce 

4 T 

Whole-wheat Cereal 
(Cracked or Granular) 

(See also page 154.) 

% c. 


208 APPENDIX 

RECIPES FOR SIMPLE DISHES 

MOST OF WHICH AEE SUITABLE FOE CHILDREN 


SOUPS 


With Meat Stock 


Beef Broth 

2 lb. shin of Beef 1 teaspoon Salt 

1 quart cold Water 1 diced Carrot 

1 small Onion 1 small Turnip 

Wipe the meat and cut the lean part in small pieces. If 
brown stock is desired, put the lean meat in a hot frying 
pan in marrow from the bone and brown well. Put bone, 
browned meat, water and salt into a soup kettle and heat 
slowly for one and one-half hours. Remove scum as it rises. 
Add vegetables, any seasonings desired, and cook for one-half 
hour. Parsley, marjoram, bay leaf, thyme, celery leaves, and 
pepper give desirable flavors if soup is used for adults only. 
Strain and cool. When cold remove the fat. This may be kept 
in a cool place and used as desired for broth or as a stock for 
vegetable soups. A white soup stock may be made by using 
knuckle of veal. 

Bean Soup 

Beans 1 cup tomatoes (Strained) 

1 quart Water Salt 

1 slice Onion 

2 cups cold baked or boiled beans 

Put the beans, water and onion in a kettle and simmer 
twenty minutes. Rub through a sieve. Add strained toma¬ 
toes, season. Reheat. 

Corn Soup 

1 can Corn Salt 

1 quart Meat Stock 

Add stock to corn and simmer 20 minutes. Rub through 
a sieve. Season and reheat. 





APPENDIX 209 

Tomato Soup 

2 cups strained Tomatoes. Salt 
1 cup Meat Stock 

Add stock to tomatoes and simmer 20 minutes. Season. 

With White Sauce 

White Sauce I 

Vs to Vt cup Butter 1 quart milk, vegetable juice 

V4 cup Flour or part Water 

Salt 

Flavoring: y 2 Onion 

1 sprig Parsley- 
Celery Leaves 
1 Bay Leaf 

Any strong juiced or flavored vegetable. 
Mix butter and flour. Add to the scalded milk. Cook in 
double boiler five minutes. Omit flavoring for younger children. 

Cream of Asparagus soup 

1 can Asparagus Salt 

1 quart White Sauce Seasoning 

Drain and rinse asparagus. Reserve tips. Push stalks 
through a sieve and add to the white sauce. Season, add tips 
and reheat. 


Cream of Cauliflower Soup 

1 Cauliflower (small) Salt 

1 quart White Sauce Seasonings 

Soak cauliflower, head down, for one hour in cold salted 
water. Cook in boiling salted water twenty minutes. Reserve 
one cup of flowerets and rub the rest through a sieve. Add to 
the white sauce. Season, add the flowerets and reheat. 

Cream of Carrot Soup 

1 pint Carrots Salt 

1 quart White Sauce Seasonings 

Wash and scrape the carrots. Cook in boiling salted 
water until tender. Push through a sieve. Add to the white 
sauce, season and reheat. 

14 


210 


APPENDIX 

Cream, of Celery Soup 


3 cups Celery Salt 

1 quart White Sauce Seasonings 

Cook celery in small amount of water ten minutes. Push 

through a sieve. Add to the white sauce, season and reheat. 

Cream, of Clam Soup 

1 pint Clams Salt 

1 quart White Sauce Seasonings 

Clean and pick over clams. Add liquor to hard part of 
clams, finely chopped and simmer twenty minutes. Add this 
and soft part of clams to white sauce. Season and reheat. 

Cream of Lettuce Soup 

2 heads Lettuce Salt 

3 cups White Sauce Seasonings 

2 tablespoons Pice 

Cook the rice until tender in on£ cup boiling water. Add 
it, the very finely chopped lettuce, and seasonings to the 
white sauce. Cook fifteen minutes in a double boiler. 

Oyster Stew 

1 quart Oysters 4 tablespoons Butter 

1 quart Milk Salt 

Wash and pick over oysters. Heat liquor to boiling point 
and strain. Add oysters and milk to the liquor and cook 
until the oyster edges begin to curl. Add butter and salt. 

Cream of Pea Soup 

1 can Peas Salt 

1 quart White Sauce Seasonings 

Drain liquor from peas. Push through sieve and add to 
white sauce. Season and reheat. 



APPENDIX 


211 


Cream of Potato Soup 

2 cups cooked Potatoes Salt 

1 quart White Sauce Seasonings 

Rub potatoes through a sieve and add to the white sauce. 
Add seasonings and reheat. 

Cream of Spinach Soup 

1 cup cooked Spinach Salt 

1 quart White Sauce Seasonings 

Rub spinach through a sieve and add to the white sauce. 
Add seasonings and reheat. 


Cream of String Bean Soup 

2 cups String Beans Salt 

1 pint White Sauce Seasonings 

Cook beans until soft in boiling salted water to cover. 
Push through a sieve. Add liquor and pulp to white sauce. 
Season and reheat. 


CEREALS 

Methods of Preparation. 

1. Put required amount of water and salt in the top 
of the double boiler and heat directly over the flame to the 
boiling point. Drop in the cereal so slowly that the water 
keeps bubbling violently. Stir constantly. Cook directly 
over the flame for five minutes. Complete cooking in the 
double boiler for 30 minutes to one hour—more if flavor of 
long cooked cereal is preferred. 

2. Mix equal amount of water and cereal, though finely 
divided cereals require more water. Add to the boiling salted 
water. Cook directly over the flame for five minutes. Com¬ 
plete cooking in a double boiler, over an asbestos pad, or 
directly over a slow wood fire. Cook for 30 minutes without 
double boiler or from one to two hours if double boiler is used. 


212 


APPENDIX 


3. (This method is especially good for whole-grain wheat 
and oat cereals.) Soak one cup of cereal in four cups of 
cold water over night in single boiler. The next morning 
bring to a boil directly over fire. Stir well, cover and cook 
slowly for 30 minutes over an asbestos mat, or one hour in 
double boiler. 


Bran Mash. 

1 cup Bran 1 tablespoon Agar-agar 

1 pint Water % teaspoon Salt 

Put the ingredients in a sauce pan and heat slowly to 
the boiling point. Simmer for ten minutes or until the Agar- 
agar is dissolved. Pour into a loaf pan and allow to solidify 
at room temperature. Serve sliced with sugar and cream 
for cases of constipation. A thin slice added to a cooked 
cereal is often more appetizing. 

Cornmeal Mush. 

1 cup Cornmeal 1 teaspoon Salt 

5 cups Water 

Use any of the above methods of preparation. 

Cream of Barley. 

1 cup Cream of Barley 1 teaspoon Salt 

4 cups Water 

Use any of the above methods of preparation. 

Cream of Rye. 

1 cup Cream of Rye 1 teaspoon Salt 

4 cups Water 

Use any of the above methods of preparation. 

Cream of Wheat. 

1 cup Cream of Wheat 1 y 2 teaspoons Salt 

6 cups Water 

Use any of the above methods of preparation. 
Farina 

% cup Farina “ ^1 teaspoon Salt 

4 cups Water 

Use any of the above methods of preparation. 


APPENDIX 


213 


Hominy Grits. 

1 cup granulated Hominy ly 8 teaspoons Salt 
4 cups Water 

Use any of the above methods of preparation. 

Hulled Wheat. 

1 cup Hulled Wheat 1 teaspoon Salt 

3 cups Water 

Look over the wheat, wash and drain. Soak in cold 
water eight hours. Add salt and heat to the boiling point. 
Boil for ten minutes. Finish cooking in a double boiler for 
two hours or fireless cooker for six hours. 

Oatmeal. 

1 cup Oatmeal (coarse) 1 teaspoon Salt 

4 cups Water 

Use any of the above methods of preparation. 

Rice. ( Boiled) 

1 cup Pice 1 teaspoon Salt 

8 cups Boiling Water 

Pick over the rice. Wash until the water is clear. Drop 
into the boiling salted water which is kept bubbling violently. 
Boil thirty minutes or until soft. All the water should have 
disappeared. If any is left, drain and use for soup. Pour 
over the rice one quart hot water. Peturn to kettle and place 
uncovered on back of range to dry off. Kernels should be 
distinct; when stirring use a fork to prevent breaking kernels. 

Rice. ( Steamed ) 

1 cup Pice 1 teaspoon Salt 

3 cups W^ater or Milk 

Pick over the rice. Wash until the water is clear. Put 
salt and water or milk in the top of the bouble boiler and 
place on range. Add rice, stirring with a fork. Cook five 
minutes, cover, place over under part of double boiler and 
steam 45 minutes or until kernels are soft. Uncover so steam 
may escape. 


214 


APPENDIX 

Rolled Oats. 


1 cup Rolled Oats 1 teaspoon Salt 

3 cups Water 

Use any of the above methods of preparation. 

Scottish Oatmeal. 

1 cup Oats 1 teaspoon Salt 

4 cups Water 

Use any of the above methods, though No. 3 gives the 
best results. 


Wheat Germ 

1 cup Wheat Germ 1 teaspoon Salt 

4 cups Water 

Use any of the above methods of preparation. 
Wheat Granules. 

1 cup Granules 4 cups Water 

1 teaspoon Salt 

Cook by method No. 3 for best results. 

Wheat Flakes. 

1 cup Flakes 1 teaspoon Salt 

4 cups Water 

Use any of the above methods of preparation. 

MEATS 


Beef. 


Flame Broiled Steak. 

Wipe with a damp cloth and trim off superfluous fat. 
Oil the wire broiler with some of the fat and place meat on 
the rack. Turn as soon as seared on one side and continue 
turning every minute until the meat is well seared all over, 


APPENDIX 


215 


then turn occasionally until cooked as thoroughly as desired. 
Steak cut one inch thick will take ten minutes, if liked rare; 
15 minutes, if well done. Remove to hot platter, spread with 
butter and season with salt and pepper. 

Pan Broiled Steak. 

Prepare as above. Oil a heavy frying pan with some of 
the superfluous fat. When this is smoking hot put in the 
steak. Continue as above. 

Broiled Liver. 

Cover liver with boiling salted water for five minutes to 
draw out blood; drain. Sprinkle with salt. Place on an oiled 
wire broiler or in a heavy skillet and broil five minutes, turn¬ 
ing often. Remove to hot platter, spread with butter and season. 

Liver Loaf No. 1. 

(For Children). 

Put one-half pound of fresh calves’ liver through the meat 
grinder, using a fine knife. Add salt and mix with two table¬ 
spoons graham flour or bread crumbs, or one egg yolk. Put 
into a small pan or casserole containing a tablespoon of melted 
butter. Bake slowly for 30 to 40 minutes. 

Liver Loaf No. 2. 

Parboil 2 pounds liver and then put through a food 
chopper. Place in a bowl, add 2 chopped onions and one cup 
fine bread crumbs. Season with salt, paprika and herbs. Mix 
thoroughly and pack in well greased mould (loaf shaped). Set 
in large pan containing warm water. Bake for 50 minutes in 
moderate oven. Serve hot with cole slaw. 

Liver and Spinach. 

Use one-half pound liver: scald, wipe dry, dredge in flour 
and broil in small amount of bacon fat. When tender remove 
from fire and put on hot bed of steamed spinach that has been 
seasoned with salt, pepper and lemon juice. Make thick milk 


216 


APPENDIX 


gravy from pan in which liver was cooked and pour over 
liver and spinach, or serve plain without gravy. 

Roast Beef. 

Wipe the meat with a damp cloth. Pub with salt and 
dredge in flour. Put in roaster and sear quickly in a hot oven. 
If meat is very lean, add fat trimmings to the pan. Baste every 
fifteen minutes. Decrease the heat after meat is well browned. 

Lamb and Mutton. 


Flame Broiled Chops. 

Wipe chops, remove superfluous fat and place in a hot 
broiler oiled with mutton fat. Turn as soon as seared. Com¬ 
plete cooking for 12-15 minutes at a slightly lowered 
temperature. 

Pan Broiled Chops. 

Same as above, but use a heavy skillet in place of 
a broiler. 


Boiled Leg of Mutton. 

Wipe meat, place in kettle and cover with boiling water. 
Bring quickly to boiling point, boil five minutes, and skim. 
Simmer until meat is tender. When half done add one table¬ 
spoon salt. 

Kidney Rolls. 

Mix one-half cup stale bread crumbs, one-half small onion 
finely chopped and one-half tablespoon finely chopped parsley. 
Season with salt and moisten with beaten egg. Spread mix¬ 
ture on thin slices of bacon and fasten around pieces of 
lamb’s kidney, using skewers. Bake in a hot oven twenty 
minutes. 

Roast Leg of Lamb. 

Remove caul and wipe meat, sprinkle with salt and pepper 
and dredge meat and pan with flour. Place in hot oven 


APPENDIX 


217 


and baste as soon as flour in pan is brown and every fifteen 
minutes thereafter until meat is done. Add small amount 
water to pan if necessary. 

VEGETABLES 

All vegetables should be washed in cold water and cooked 
until soft in a small amount of boiling salted water in a covered 
kettle, unless it is desirable to remove some flavor. In this 
case start the process in cold water and leave the kettle 
uncovered. If vegetable water is not served with the vege¬ 
tables, save and use for soup. Avoid overcooking vegetables; 
use the uncooked vegetable whenever possible. For infants under 
two years all vegetables should be rubbed through a sieve. 

White Sauce II. 

Vs to y 4 cup Butter 1 pint Milk, Vegetable Juice 

y 4 cup Flour or part Water 

Mix butter and flour. Add to scalded milk. Cook in 
double boiler five minutes. 

Asparagus. 

Wash and cut off lower part of stalks as far down as 
they will snap. Cook in boiling salted water fifteen minutes, 
leaving the tips out of water the first ten minutes. Drain and 
season with butter. 


Creamed Asparagus. 

4 cups cooked Asparagus I pint White Sauce II 

String Beans. 

Remove strings and break in one inch pieces. Wash and 
cook in boiling salted water 45 minutes to one hour. Drain 
and season with butter. Meat bone, salt pork or bacon give 
good flavor to beans. 

Creamed String Beans. 

4 cups String Beans (cooked) 1 pint White Sauce II 


218 


APPENDIX 

Shell Beans. 


Wash and cook in small amount of boiling salted water 
for one to one and one-half hours. Season with butter. 

Lima Beans. 

Soak one cup lima beans over night. Drain and cook 
in small amount of boiling salted water until soft. Season 
with butter. 

Cream of Lima Beans. 

3 cups Lima Beans 1 pint White Sauce II 

Beets. 

Wash and cook in boiling salted water until tender. 
Drain, put in cold water and remove the skins. Quarter 
and season with butter. To preserve vitamins, beets may be 
pared and diced before cooking that the time for cooking may 
be shortened. 


Brussels Sprouts. 

Remove wilted leaves and soak in cold water fifteen min¬ 
utes. Cook in boiling salted water until tender. Drain and 
season with butter. 

Creamed Brussels Sprouts. 

4 cups boiled Sprouts 1 pint White Sauce II 

Scalloped Brussels Sprouts. 

Put 4 cups boiled Brussels Sprouts in an oiled baking dish, 
sprinkle with salt, add 1 pint White Sauce II. Cover with 
buttered bread crumbs and bake until browned. 

Cabbage. 

Remove outside leaves, shred and cook in salted water for 
twenty minutes. Drain and season with butter. 


APPENDIX 

Creamed Cabbage. 


219 


4 cups boiled Cabbage 1 pint White Sauce II 

2 tablespoons Vinegar, if 
desired 


Scalloped Cabbage. 

Put 4 cups boiled cabbage in an oiled baking dish. Add 
1 pint White Sauce II. Cover with buttered bread crumbs and 
bake until browned. One-half cup cheese added to White Sauce 
gives a good flavor. 


Carrots. 

Wash, scrape and slice carrots. Cook until tender in 
small amount boiling salted water. Season with butter. 

Creamed Carrots. 

4 cups boiled Carrots 1 pint White Sauce II 

Cauliflower. 

Remove leaves, cut off stalk and soak thirty minutes in 
cold salted water (head down). Cook, head up, or broken in 
flowerets in boiling salted water until tender. Drain and butter. 

Creamed Cauliflower. 

4 cups boiled Cauliflower 1 pint White Sauce II 
Juice of one lemon may be added if desired. 

Celery. 

Wash, scrape and cut stalks in one inch pieces. Cook 
until tender in boiling salted water. Drain and season 
with butter. 


Creamed Celery. 

4 cups cooked celery 1 pint White Sauce II 


220 


APPENDIX 


Corn. 

Remove husks and silks. Cook ten to twenty minutes in 
boiling water. Serve on the cob or cut from the cob and 
add butter. 


Creamed Com. 

4 cups cooked Corn 1 pint White Sauce II 

Scalloped Corn. 

Put 3 cups cooked corn in an oiled baking dish. Add 
1 pint White Sauce II. Cover with buttered bread crumbs 
and bake until nicely browned. 

Corn a la Southern. 

To one can corn add two beaten eggs, one teaspoon salt, 
one tablespoon butter and one pint milk. Bake in an oiled 
baking dish until firm. 

Greens, Spinach, or Swiss Chard. 

Pick over and wash greens. Cook in a small amount of 
boiling salted water until tender. Drain and season 
with butter. 


Onions. 

Remove skins from onions while under cold water. 
Cover with boiling salted water and boil five minutes. Drain 
and again cover with boiling salted water. Cook until ten¬ 
der. Drain and season with butter. 

Scalloped Onions. 

Cut 8 onions in quarters. Put in an oiled baking dish 
and add 1 pint White Sauce II. Cover with buttered crumbs 
and bake until nicely browned. 

Peas. 

Cook shelled peas in small amount of boiling salted water 
until tender. Season with butter. 


APPENDIX 


221 


Creamed Peas. 

4 cups cooked Peas 1 pint White Sauce II 

Spinach 

Wash carefully in running water two or three times. The 
water that clings to the leaves is sufficient for cooking. Add 
salt. Boil ten minutes. Season with butter and serve. A slice 
of bacon may be cooked with the spinach if desired. 

Squash. 

Wash squash, cut in pieces, remove seeds and stringy parts 
and pare. Cook in very small amount of boiling salted water 
or steam until tender. Mash and season with butter. 

Baked Squash. 

Prepare as above, cutting into 3 inch pieces, but do not 
pare. Bake in moderate oven until soft. 

Succotash. 

1 cup Corn y 2 teaspoon Salt 

1 cup Lima Beans 1 y 2 tablespoons Butter 

Soak lima beans in cold water over night. Drain and 
add one quart boiling water. Cook until almost tender. Add 
salt, corn and butter, and complete the cooking. 

Tomatoes. 

Wipe, skin and cut tomatoes in pieces. Cook slowly until 
tender. Season with butter and salt. 

Baked Tomatoes. 

Wipe and remove a half inch slice from the stem end of 
the tomatoes. Make a small opening in the centre of each 
tomato and fill with meat, cheese, celery, onion or any left 
oyer vegetable. Sprinkle with bread crumbs and bake 
until tender. 

Scalloped Tomatoes. 

Put a layer of bread crumbs in the bottom of an oiled 
baking dish. Add a layer of cooked, salted tomatoes. Repeat 
until dish is full having the crumbs on top. Bake until 
browned. 


222 


APPENDIX 


Turnips. 

Wash, pare, and quarter turnips. Cook until soft in very 
small amount of boiling salted water. Drain and butter or 
mash and season. 

Creamed Turnips. 

4 cups cooked Turnips 1 pint White Sauce II 

DESSERTS 

Bread Pudding. 

2 cups stale Bread Crumbs. 2 Eggs 

1 quart Milk % teaspoon Salt 

% cup Sugar 1 teaspoon Vanilla 

2 tablespoons melted Butter 3 tablespoons Raisins or Cur¬ 

rants 

Mix the ingredients in the order given. Bake in a but¬ 
tered baking dish in a slow oven for one hour. 

Baked Apples. 

6 Apples 1 cup Water 

Few drops Lemon % cup Sugar 

Wipe, core, and pare apples. Put apples in baking dish 
and add few drops of lemon to each. Fill cavity with sugar 
or make syrup of sugar and water and pour in the dish. 
Four cloves may be stuck in each apple for flavor. If apples 
are not pared, a line cut through the skin around the centre 
of the apple will prevent the skin breaking. Basting apples 
makes the skin tender. 

Baked Pears. 

8 Pears % cup Brown Sugar. 

2 tablespoons Butter 

Cut pears lengthwise, remove core and sprinkle one-half 
tablespoon brown sugar and dot of butter on each half. Bake 
until tender and browned. 


APPENDIX 


223 


Bavarian Cream. 

2 tablespoons granulated 1 pint whipping Cream 
gelatin 1 can grated Pineapple 

y 2 cup cold Water y 2 cup Sugar 

Soak Gelatin in cold water. Add the lemon juice, hot 
pineapple and sugar. If gelatin is not all dissolved, heat 
in top of double boiler. Chill. When the mixture begins to 
thicken, fold in the whipped cream. Mould and chill. 


Brown Betty. 


3 cups chopped Apples 
2 cups Bread Crumbs 
y 2 cup Sugar 
y 4 teaspoon Cinnamon 


2 tablespoons Butter 
y 4 teaspoon Nutmeg 

Juice and rind y 2 Lemon 
y 4 cup Water 


Mix sugar and spices Put one-half the crumbs in the 
bottom of a baking dish. Add one-half the apples, butter 
and seasonings. Repeat. Add water or omit if apples are 
very juicy. Bake until apples are tender. 


Carmel Junket. 


2 cups Milk Few grains Salt 

y 3 cup Sugar 1 teaspoon Vanilla 

y 3 cup boiling Water 1 tablet Junket 

Carmelize sugar, add boiling water and remelt any 
hardened sugar. Cool and add lukewarm milk. Add powdered 
junket tablet, salt and vanilla. Turn into mould, let stand 
in a warm place until set, then chill. Served with whipped 
cream and chopped nuts gives more flavor. 

Chocolate Cream. 


2 cups scalded Milk 
5 tablespoons Cornstarch 
y 2 cup Sugar 
y 4 teaspoon Salt 
1 teaspoon Vanilla 

Mix all dry ingredients, 
to scalded milk. Cook in do 


y 3 cup cold Milk 
1 y 2 square Chocolate 
3 tablespoons hot Water 
3 Egg Whites 

dilute with cold milk and add 
ible boiler until thickened. Stir 


APPENDIX 


224 

constantly. Add melted chocolate to which hot water has been 
added. Add stiffly beaten whites of eggs and vanilla. Mould 
and chill. 

Cornstarch Pudding. 

4 cups scalded Milk % teaspoon Salt 

y 2 cup cornstarch % cup cold Milk 

14 cup Sugar 1 teaspoon Vanilla 

3 Egg Whites 

Mix the dry ingredients, dilute with cold milk and add 
to scalded milk. Cook in double boiler until thickened. Stir 
constantly. Add stiffly beaten egg white, mould and chill. 

Snows. 


Whites 3 Eggs Sugar 

% cup Fruit Pulp 

Beat the egg whites until stiff. Add the hot sweetened 
fruit pulp and continue beating until thoroughly mixed. 
Pile lightly on a dish and chill. Apple, peach, apricot or 
prune pulp make good snows. 

Tapioca. 

X A cup pearl Tapioca or 1 quart quartered Apples 

2 tablespoons minute Tapioca % cup Sugar 
iy 2 cups Water 
2 cups scalded Milk 

Soak pearl tapioca if used. Cook tapioca in water until 
transparent. Put apples and sugar in a baking dish, pour 
over them the tapioca and bake until apples are done. Other 
fruits may be substituted for apples. 

Whips. 

1/3 lb. Prunes 1 cup Sugar 

5 Egg Whites % tablespoon Lemon Juice 

Wash prunes. Soak over night and cook until soft. 
Remove stones and rub through sieve. Add sugar and cook 
five minutes. Beat egg whites stiff, add cooled prune pulp 
and lemon. Pile lightly in a buttered baking dish and bake 
in a slow oven twenty minutes. 


APPENDIX 

NORMAL SALT SOLUTION 


225 


1 pint boiling Water 
I level teaspoonful Salt 

Dissolve the salt in the boiling water and let cool before 
using. This may be given per rectum as an enema, taken by 
mouth to induce vomiting, or employed as a gargle and nasal 
douche. Used in the latter way normal salt solution is very 
beneficial in the treatment of coryza or common “cold.” With 
an infant a medicine dropper is the best means of irrigating 
the nasal passages. While the child is lying on his back the 
tip of a medicine dropper, half-filled with the solution, is 
inserted into each nostril in turn, and the bulb quickly com¬ 
pressed. When the babe has a head cold which causes him to 
stop nursing to breathe, the nose should be irrigated in this 
way before each feeding. With older children a small rubber 
ear-syringe is preferable to the medicine dropper. The patient 
leans forward with his head over a pan or bowl; the syringe 
is filled with the warm salt solution, the tip is inserted not 
more than a half inch into the nostril, and the bulb is firmly 
compressed. In this way all the folds of the mucous membrane 
are deluged, yet the solution runs out freely and is not forced 
into the throat or ear passages. 

ERUPTION OF THE TEETH 

The Temporary Teeth 


The 2 lower central incisors. 5-8 Months 

The 2 upper central incisors. 7-9 Months 

The 2 upper lateral incisors. 7-11 Months 

The 2 lower lateral incisors. 9-12 Months 

First Molars (4) . 12-16 Months 

Canines (4) . 14-20 Months 

Second Molars (4) . 20-32 Months 


The above table represents the average time and order of 
the eruption of the temporary teeth. There are wide variations 
however. The first incisors may erupt as early as the third 
month or not until the child is nearly a year old. The order 
in which they appear may vary slightly also in individual 
cases. These are exceptions, however, and not the rule. 

15 









226 


APPENDIX 

The Permanent Teeth. 


The following table gives a fairly correct idea of the time 
and order in which the permanent teeth erupt: 


First Molars .. 
Central incisors 
Lateral incisors 
First bicuspids 
Second bicuspids 

Cuspids . 

Second Molars . 
Third Molars . . 


5-7 years 
6%- 8 years 
7 - 9 years 

9 -11 years 

10 -12 years 

11 -14 years 

11%-13 years 
16 -21 or later 


TABLE OF HEIGHTS AND WEIGHTS 




BOYS 


GIRLS 

Age 

Height 

Weight 

Height 

Weight 

Inches 

Pounds 

Inches 

Pounds 

Birth . 

.. . .20% 

7% 

20% 

7% 

6 months .. 

.. 25% 

16 

25 

15% 

12 months . . 

. . . 29% 

21% 

28% 

21 

18 months . 

...31 

23% 

30 

22% 

2 years .... 

... 33% 

27 

32% 

26 

3 years .. . 

... 36% 

32 

35 

30% 

4 years . . . 

. . . 39 

36 

38% 

35 

5 years .. . 

... 41% 

41 

41% 

40 

6 years ... 

. .. 44 

45 

43% 

43% 

7 years ... 

...46 

49% 

45% 

48 

8 years ... 

. .. 48 

54 

48 

53 

9 years .. . 

... 49% 

60 

49% 

57% 

10 years ... 

...52 

66 

51% 

63 

11 years ... 

... 53% 

71% 

53% 

70 

12 vears 


79 

66 

80 



13 years ... 

... 57% 

86 

58% 

90 

[14 years ... 

...60 

97 

60 

99 

15 years ... 

... 62% 

108 

61% 

107 

16 years ... 

...65 

122 

62 

113 
































APPENDIX 


227 

MEASUREMENTS 


Age 

Height 

Chest 

Head 


Inches 

Inches 

Inches 

Birth . 

. 20% 

13% 

13% 

6 months . 

. 25% 

16 

17 

12 months . 

. 29% 

18 

18 

18 months . 

. 31 

18% 

18% 

2 years . 

. 33% 

19% 

19 

5 years . 

. 41% 

21 

20 












INDEX 


Adenoids, 79 

from thumb sucking, 196 
from bottle-feeding, 79 
Anemia 

in breast-fed, 126 
on milk diet, 61 
Animal experiments 
calf, 27 
dogs, 54, 55 
rats, 38, 41, 42 
Antiseptics, 151, 191 
for gargles, 193 
in mouth, 192 
on navel, 192 
on nipples, 85, 192 
Appetite, 60, 159, 162, 170, 
181, 191 

Apples 
sauce, 133 
baked, 222 

Artificial feeding, 95, 142 
foods, 75 
care of food, 146 
general directions, 156 
preparation of food, 147 
schedule, 152 
selection of food, 145 
technique of, 150 
Asthma, 183 

Bacteria in milk, 78 
Bands for infants, 189 
Bedtime stories, 202 
Beef 

broth, 208 
scraped, 136 
steak, 214 
Beri-beri, 39 

Boiling milk, method of, 147 
Bottles 

care of, 151 
kind, 103, 150 
position, 150 


Bowel movements, 174, 200 
Bread 

toasted, 129 
white, 40 
whole wheat, 71 
Breakfast 

for mother, 71 
for infant, 134 
for older child, 158 
Breast development 

normal and abnormal, 88 
Breast feeding, 73 
abnormal cases, 103 
capability of, 81, 144 
effects on child, 74 
effects on jaw, 79 
effects on mentality, 80 
effect on mother, 73, 74 
effect on muscles, 80 
effect on teeth, 78 
errors in, 90 
method of, 85, 86, 98 
prevalence of, 115 
reduction of, 108 
regularity of, 87, 104 
weaning from, 83 
Breast-milk 
care of, 101 

compared with cow’s milk, 
75 

composition of, 75 
development of, 95, 98 
fats in, 69, 83 
insufficiency of, 93 
origin of, 66 
protein of, 69 
quality of, 83 
rickets on, 69 
testing of, 83 


229 


230 INDEX 


Breast-milk, development of, 
95, 103 

cases, 110-115 
chart, 112 

conduct of, 102, 111, 113 

diet in, 97 

drugs in, 95 

in foster mothers, 104 

massage, 96 

process, 98, 99 

Breast-milk, expression of, 
111, 113 
method, 98, 99 
motions in, 104 
technique of, 100 
Breast-milk, insufficiency of, 
109 

causes, 93, 94, 95, 108, 109, 
110, 115 

for premature, 119 
treatment, 98, 99, 107, 108, 
109 

Breast pump, 97 
Breck feeder, 120 
Broths, 131, 208 
Butter, 160 

amount required, 164 
caloric value of, 23 
digestibility, 133, 164 
vitamin value, 31, 164 
B-vitamin, 33, 39, 41 

Cabbage, 71 
for infants, 35 
in scurvy, 45 
juice, 34, 70 
recipes for, 218 
vitamin content of, 34 
Calcium, 21, 52, 55, 57, 61 
Calories, 23, 154 
table of, 203 
Carbohydrates, 19 
Care of 

cow’s milk, 146 
expressed milk, 101 
' nipples, 85, 101 

premature infant, 118, 122 
teeth, 63, 64, 68, 69, 78, 
167, 168 


Carrots 

for infants, 128 
recipes for, 209 
salad, 162 

vitamin content of, 33 
Casein in milk, 75 
Cathartics, 85, 173, 174, 199 
Cauliflower 

for children, 36 
recipes, 209 
vitamin content of, 36 
Celery 

for lunches, 162 
for sandwiches, 171 
recipes for, 219 
Cereal 

jelly, 149, 152 
jelly, thick, 149 
water, 149, 152 
Cereals, 33, 163 

chart of food value of, 161 
in constipation, 85 
in infancy, 126, 128, 132 
methods of cooking, 132, 133 
prepared, 161 
recipes for, 211-214 
refined, 33 
whole grain, 36 
Certified milk, 147 
Cleanliness of food, 201 
Cheese, 160 
Cocoa, 71, 166 
Coffee, 166 
Colds, 174 

causes of, 181 
effect on nursing, 108 
treatment of, 174 
Colic, 91, 92 

Complementary feedings, 105, 
112, 113 

Compresses, cold, 173, 175 
Condensed milks, 146 
Constipation, 174, 200 
Corrective measures, 181, 187, 
188 

for thumb sucking, 197 
of over feeding, 94 
of under feeding, 94 


INDEX 


231 


Death rate, 76 
in bottle-fed, 76 
in breast-fed, 76, 77 
Destructive influences on 
foods, 35 

Desserts, 137, 217-221 
Development of breast-milk, 
110-112 
chart of, 112 
Diet, effect of, 26 

diseases from, 29, 37, 38, 
39, 43 

during lactation, 59, 71, 97, 

111 

Diet, during infancy, 116, 
124-140 

during pregnancy, 59-65 
effect on nursing mother, 42 
effect on reproductive or¬ 
gans, 41 

effect on teeth, 64, 68, 69, 
78, 114 

of pre-school child, 157-169 
of school child, 169-172 
on breast-milk, 97 
whole milk in, 133, 152, 160 
Diets, faulty, 177 
Dietary precautions, 60 
Diluents, 149 
Dinner, for infants, 158 
for older child, 171 
for mother, 71 
Diseases, deficiency, 37 
beri-beri, 39 
eye affections, 37 
night blindness, 39 
polyneuritis, 39 
rickets, 38 
scurvy, 29, 43, 70 
xerophthalmia, 37 

Eczema, 92, 183 
Eggs, 135, 185 
dangers of, 67 
excess of, 182, 184 
in mother’s diet, 67 
vitamin value of, 32 
yolk, 31 

Elements of food, 19 
Enema, 173 


Energy foods, 19, 20 
Errors in infant feeding, 90, 
178 

Establishment of breast-milk, 
103 

Experimental studies, in ce¬ 
reals, 161 

in vitamins, 38, 53, 54, 55 
in puppies, 54, 55 
in rats, 38, 41, 43 
on rickets, 53, 55 

Facial expression, 177 
Fats, 19, 75, 164 
excess of, 180 
indigestion, 179, 180 
kinds of, 180 

Fats, percentages in breast- 
milk, 69, 83 
use of, in body, 19 
Fat-soluble A, 31, 32, 38, 45, 
46, 53, 65, 69, 70 
Faulty diets, 177 
Feedings, number of, 105, 152 
Food, kind of, 67 
amount of, 66 
artificial, 75 
care of, 201 
Food elements, 19 
Food groups, 160 
Fondling of children, 194, 195 
Fruit, 31, 34, 160, 165, 201 
in infancy, 133 
in mother’s diet, 65, 67 
Fuel factors, 19 


Gas in stomach, 86 
Gargling, 193 
Gravy, 133, 174 
Growth, dependence of, upon 
vitamins, 39, 42 


Habits of eating, 159 
of pacifiers, 197 
of thumb sucking, 196 
Handling of infants, 195 
Height and weight chart, 227 
Heliotherapy, 57, 190 


232 


INDEX 


Ice cream, 167 
Incubator, 118 
Indigestion, acute, 92 
caused by fats, 180 
caused by sugar, 178, 181 
treatment of, 173, 179 
Infant feeding, errors in, i78 
artificial, 95, 142 
maternal, 73 

Infections, nasal, 144, 172 
in diarrhoea, 199 
in prematures, 121 
Insanity, among bottle-fed, 81 
Intervals of feeding, 87, 152 
Immature infant, 117 

Kissing, 195 

Lactation, diet during, 65-72 
hygiene of, 84 
sample menus for, 71, 72 
Laxatives, 61, 67, 68, 174 
Lime, 21, 52, 61 
Liquids, in pregnancy, 61 
for children, 166 
in lactation, 84 
in illness, 22 

Liver, vitamin content of, 32 
for infants, 139 
for older child, 140, 163 
recipes, 139, 140, 215 
Loss of appetite, 92, 191 
Lunches for infants, 137-159 
for school, 170, 136 

Malnutrition in well-to-do, 
178, 190 

in young children, 124 
Malocclusion, 50 
Manual expression, 98, 99, 

107, 108, 109 

results of, 105, 107, 109, 
110, 111, 113 
Massage, 96 
Meals, 136, 158 
Meat, 139, 140 

recipes for, 214, 215 
scraped (for infants), 136 
Measures, equivalent, 154 
Measurements, body, 227 


Menstruation of nursing 
mother, 82, 108 
Metabolism, 19 
Minerals, 21, 52, 57, 61 
Mouth, care of, 192 
Movements, 174, 200 
Milk, breast 

development of, 95, 98 
value of, 75, 79 
Milk, cow’s, 160 
boiled, 132 

compared with human, 75 
condensed, 146 
formulas, 152 

Navel, care of, 192 
Nasal douche, 175 
Neck, compresses to, 175 
Nipples, care of mother’s, 85, 
101, 192 

difficult for nursing, 88, 93, 
painful, 85 
rubber, 150, 151 
spastic, 107, 109 
Normal salt solution, 193, 225 
Nursing apparatus, 150, 151 
Nursing, maternal, 73-115 
alternate, 87 
capability of, 81 
diet during, 59, 71, 97 
division of period, 89 
effect on child, 74 
effect on mother, 73 
effect on teeth, 78, 79 
pregnancy during, 82 
schedule for, 87 
technique of, 85, 86 
vitamin requirements dur¬ 
ing, 68 

Nutrition, history of, 19 
newer knowledge of, 26 

Older children, diet of, 157 
Oleomargarine, 32 
Orange juice, 29, 34, 43, 70, 
125, 130, 153 

Over feeding of breast-fed 
infants, 90, 92 
correction of, 94 


INDEX 233 


Pacifiers, 197 
Pasteurized milk, 147 
Percentages in breast-milk, 83 
Perversions of taste, 186 
Play, 157, 159 
Phosphorus, 21 
Polyneuritis, 39 
Potato, 133 
Precocious child, 202 
Pregnancy, diet of, 59 

amount of food required, 60 
dietary precautions of, 60 
mineral requirements in, 61 
sample menus for, 71 
vitamin requirements of, 63, 
65 

Pregnancy of nursing mother, 
82 

Premature infant, 116 
care of, 118-122 
cause of, 116 
characteristics of, 117 
feeding of, 119-122 
food requirements of, 120 
temperature of, 119 
weight of, 116, 117 
Proprietary foods, 145, 146 
Protein, 20 

excess of, 162, 182 
in cow’s milk, 75 
in mother’s diet, 67 


Recipes, 202-227 
for cereals, 211-214 
for cereal water, 149 
for cereal jelly, 149 
for desserts, 221-224 
for meats, 136, 214-216 
for salads, 162 
for soups, 208-211 
for vegetables, 217-221 
Reduction of breast-milk, 108 
Re-establishment of breast- 
milk, 103, 104, 112-115 
chart of, 114 

Reheating foods, 33, 35, 61 
Regularity of feeding, 87, 104 
of habits, 134 
of meals, 134 


Reproduction, influenced by 
diet, 42 
Rickets, 48 
cause of, 52 
deformities from, 50 
effect of diet on, 55, 56 
effect of exercise on, 52 
effect of sunlight on, 53, 56 
experiments in, 54, 55 
from preserved milk, 146 
from whole milk, 179 
in breast-fed child, 69 
in negroes, 67 
in the premature, 122 
prevention of, 56 
symptoms of, 48 


Saline solution, 193, 225 
Salts in milk, 75 
Salts, mineral, 21, 52 
Sandwiches, 171 
Scales for infant weighing, 89 
Schedule for breast-feeding, 87 
for 6 months, 125 
for 7 months, 127 
for 8 months, 130 
for 9 months, 132 
for 10 months, 134 
for 15 months, 136 
for 18 months, 137 
for 21 months, 138 
Schedule for artificial feeding, 
152 

at 8 months, 153 
at 9 months, 154 
School age, diet, 169 
lunches for, 170, 186 
Scurvy, 62 
cure of, 45 

on proprietary foods, 145 
Seasonal effect on vitamins, 
31, 63 

Second summer, 198 
Sleep, 158, 193, 194 
Soups, 208-211 
Spinach 

cooking of, 36, 131 
for infants, 127, 217 
soup, 211 


234 


INDEX 


Spinach, 

recipes, 221 

vitamin content of, 34 
Starches, 19 
excess of, 178 

Stools, frequency of, 174, 199 
Stories, bedtime, 202 
Sugar, 19, 152 
Suggestion, 202 
Supper, 136, 159 
Sunlight treatment, 53, 55, 
57, 190 

in anemia, 190 
in rickets, 53, 56 

Tea, 166 

in indigestion, 173 
Technique of nursing, 85, 86 
of manual expression, 100 
Teeth 

care of, 167, 168 
early removal of, 169 
effect of breast-feeding on, 
78, 114 

effect of thumb sucking, 196 
eruption of, 225, 226 
exercise for, 129 
food requirements for, 63, 
64, 68 

irregularities, 169 
malocclusion of, 50 
separation of, 168 
Teething, 198 
Thumb sucking, 196 
Toast, 129, 138, 159 
Tomato, calories of, 23 
for infants, 126 
recipes, 221 
soup, 209 

vitamin content of, 33, 34 
Toys, 201 
Treatment 
of colds, 174 
of constipation, 174, 199 
sunlight, 190 

Tuberculosis of nursing 
mother, 81 

Turnips, vitamin value of, 36 
recipes for, 222 
Twins, 108, 116 


Under feeding, 93 
causes of, 93, 94 
correction of, 95 

Vegetables, 160 

cooking of, 36, 217 
for infants, 127, 128, 133 
for raw salad, 162 
in constipation, 174, 200 
in lactation, 70 
in pregnancy, 69 
vitamin value of, 31, 32, 33, 
34, 35 

Water, 21 

for infants, 125 
for premature infant, 121 
in disease, 22 
in pregnancy, 61 
Water, soluble B, 33, 39, 46, 
65 

Water, soluble C, 34, 43, 46, 
70 

Weakness of baby, 103, 108, 
112 

of child, 93 

Weaning of breast-fed infants, 
132, 133, 155 

effect of vitamins after, 42 
excuses for, 83 
Weaning, from bottle, 155 
reasons for, 81 

Weight and height chart, 227 
Weight, average, 90 
abnormal, 179 
increase in, 112 
decrease in, 113 
Weighing, value of, 89 
Wet-nurse, 109, 144 
in breast feeding, 111 
Wheat, whole 

bread, 71, 133, 138 
cereals, 132, 160 
Woolens, 189 

Xerophthalmia, 37 

Yeast,. 34 















































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* 
































































0 


I 

































































